Patient Financial Coordinator

Location: Burlington, MA
Job ID: 171468-1A
Date Posted: Dec 1, 2021
Category: Specialist

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Job Description

Welcome To

Welcome to Lahey Hospital & Medical Center, part of Beth Israel Lahey Health. Lahey Hospital & Medical Center is a world-renowned tertiary medical center known for its innovative technology, pioneering medical treatment and leading-edge research. A teaching hospital of Tufts University School of Medicine, the hospital provides quality health care in virtually every specialty and subspecialty, from primary care to cancer diagnosis and treatment to kidney and liver transplantation. It is a national leader in a number of health care areas, including stroke, weight management and lung screenings, among many others. Lahey also helps to advance medicine through research and the education of tomorrow's health care leaders.

About the Job

Under the general supervision of the Director of Executive-International Health, accepts, triages and processes patient, physician and company access and customer service issues. Provides referrer, employer, insurance companies, clinic departments and private industry with followup information and coordinates services as requested. Maintains and updates a client database and generates information to and from clients. Ensure payment for services is collected in the most ethical and timely manner; achieves the optimum level of reimbursement for services rendered; ensures all billing is done in compliance with federal, state and local regulations; Provides accurate financial information to assist in decision making; Meets and exceeds customer expectations of service.

Principal Duties and Responsibilities:

  • Develops/Proposes appropriate internal departmental billing guidelines that ensure legal compliance and follows Lahey Clinic ethical standards and Federal, State and Local guidelines.
  • Manages billing functions for Executive and International customers.
  • Designs and implements a department billing system that integrates with the overall Lahey billing & AIR system.
  • Responsible for the coordination of all departmental billing functions with Lahey patient accounts department.
  • Generate monthly reports and provide a summary analysis to Manager, V.P. and Director of program.
  • Utilizes system to enroll company information in the Executive Health-International Medicine Program and generate required documents from the database to clients and clinic staff/departments.
  • Develops, implements, and ensures compliance with departmental policies and procedures.
  • Regularly reviews clinical billing encounter forms and cross references to patient medical records to ensure proper coding and clinical documentation.
  • Reviews billing encounter froms as necessary to evaluate possible changes in coding process to ensure appropriate reimbursement for executive & international services.
  • Reviews third party government regulations and third party ensurer requirements to ensure departmental coding compliance.
  • Conducts annual fee analysis of Executive health & International Medicine services and recommends fees for new codes as is necessary.
  • Develops and conducts a schedule of physician billing audits within designated specialty or specialties, presenting statistical results and analysis of coding review and providing specific recommendations for improvement in billing related to Executive or International services.
  • Conducts new physician orientation and on going physician training in appropriate documentation and coding policies with in designated specialty.
  • Reviews and analyzes rejected claims and patient inquiries and recommends appropriate coding corrections.
  • Provides ongoing guidance and training to Executive Health-International Medicine Coordinators/Specialists.
  • Collects appropriate information to register and schedule Executive Health-International Medicine clients to create access to the Lahey Clinic provider.
  • Follows established Protocol in provider selection.
  • Notifies appropriate personnel of the scheduled appointment to ensure customer access.
  • Provide post appointment verification and followup procedure as required by the company.
  • Continually update/educate department staff on any changes to protocoVprocedure.
  • Interacts with designated company personnel;Embassy personnel, and Governmental agencies to meet requirements.
  • Interacts with Executive Health-International medicine customers designee to request and provide information as requested.
  • Interacts and facilitates services and information with clinic departments including but not limited to, Internal medicine, Cardiac services, Ophthamology, Laboratory, Medical records and Billing.
  • Provides customer service and retention functions with clients companies and other referral sources.
  • Interacts in person and/or by phone with designated company representative and referrer representative as requested.
  • Triage all requests and information to Executive Health-International Medicine staff.
  • Serves as company/referrer liaison to internal clinic departments.
  • Perform other duties as assigned, or directed, to ensure the smooth operation of the department.
  • Communicates and works with other finacial supervisors, section leaders and other members of the team to increase effectiveness and efficiency of the overall office function and performance, i.e. coding, registration, reimbursement and customer service related issues.
  • Attends and participates in inter-intra department meetings as required.
  • Serves as company/referrer liason to internal clinic departments.
  • Generates department reports as requested.
  • Demonstrates responsiveness, initiative, and resourcefulness in job responsibilities and customer interaction.
  • Maintains and frequently updates customer appointment information as needed.
  • Maintain company files regarding customer appointment information.

 

Additional Duties:

  • Work accounts from point of patient contact with Lahey to account reconciliation for both professional and hospital services rendered within Executive & International Health.
  • Responsible for the coordination of collection activity and rebilling for specific patient receivables ensuring timely claim submission and resolution of all patient accounts in the assigned receivables.
  • Reconcile claim edits for paper and electronic submitted claims.
  • Resolve claim edits relating to registration/billing.
  • Print and submit paper claims to insurers.
  • Prepare case rate packages to provide to insurer.
  • Review and distribute correspondences received.
  • Research return mail issues.
  • Process International self-pay and executive credit card payments.
  • Post executive health checks and client account checks.
  • Review all charges on Executive Health accounts and extract diagnostic services to insurance confirming proper coding is correct to ensure appropriate reimbursement.
  • Transfer prepayments to resolve accounts.
  • Prepare manual invoice and itemized bill for client and executive health accounts after confirming all charges are appropriate and submit for reimbursement.
  • Bill executive health patients for outstanding balances.
  • Maintain accuracy of fee schedules for executive health billing.
  • Review all charges for International Health account.
  • Apply International Health courtesy discounts to charges.
  • Transfer prepayments to resolve accounts.
  • Bill International health patients for outstanding balances.
  • Make outgoing calls and sends correspondence to patients and responsible parties on outstanding account receivables.
  • Responsible for evaluating, processing and resolving patient complaints in accordance to Lahey policy and procedure.
  • Responsible for responding to and processing patient billing inquiries.
  • Manage Embassy sponsored accounts.
  • Manage philanthropy patients invoicing for services rendered to clients within Executive-International Health.
  • Prepare invoices for services provided off site to Executive-International Health patients.
  • International generic payors-analyze accounts to determine what financial class they belong to within the Institution.
  • Call insurance companies to confirm eligibility and obtain cert if needed.
  • Obtain TPA network home plan information on travel insurance policies.
  • Provide estimates –utilize n ’thrive system to produce estimates for insurance, self-pay patients related to upcoming outpt/inpt services.
  • Review account to see if qualifies for sur charge fee and advise patient.
  • Confirm financial clearance for self-pay patients. Meet with patients and discuss finances-set up payment plans if appropriate
  • Credit reconciliation-transfer $ to appropriate accounts for self-pay-research insurance credits for proper resolution.
  • Work denials-request medical notes or follow up with revenue control analysts for reconciliation.
  • Reviews and analyzes rejected claims and patient inquiries and recommends appropriate coding corrections.
  • Reviews third party government regulations and third party insurance requirements to ensure departmental coding compliance.
  • File appeals with appropriate supporting documentation.
  • Review late charges and take appropriate action.
  • Review and copy checks upon receipt.
  • Ensure reimbursements are paid per contract and follow up with discrepancies.
  • Provide reports detailing aged accounts for resolution to insurers.
  • Participate in monthly conference calls with VP, directors of our office and the TPA administration.
  • Process checks not drawn on US bank through foreign deposit process.
  • Reviews and responds to inquiries and requests from clinical dept., coding and patient financial service colleagues.
  • Provide cost to dates upon request from insurers.
  • Assist the Program Health Specialist with incoming patient calls relating to appointments, transportation, referrals, and doc referrals.
  • Available to assist in EH clinic when needed.
  • Registers new patients.
  • Fix registration issues.
  • Attends and participates in inter-intra departmental meetings as required.
  • Generates department reports as requested.
  • Provide ongoing guidance and training to Executive-international Medicine Coordinators/Specialists.
  • Participate in revenue improvement initiatives.
  • Maintain and adheres to the Lahey Clinic Confidentially policy.
  • Incorporates Lahey Clinic Guiding Principles, Mission Statements and Goals into daily activities.
  • Complies with all Lahey Policies.
  • Maintains courteous and effective interactions with colleagues and patients.
  • Maintain strong relationships with insurers.
  • Demonstrates a commitment toward meeting and exceeding the needs of our customers and consistently adheres to customer service standards.
  • Participates in departmental and or interdepartmental quality improvement activities.
  • Participates in and successfully completes Mandatory Education.
  • Performs all other duties as needed or directed to meet the needs of the department.
  • Responsible for ensuring the patient experience in accessing healthcare at LHCM is efficient and welcoming and that the patient confidentiality is respected and patient safety is preserved Ensure that all proper patient financial and demographic information is obtained and processes so LHCM is fully reimbursed for clinical and hospital services provided.

 

Minimum Qualifications:

Education: Bachelors Degree or equivalent education and experience.

Licensure, Certification, Registration: Professional coding certification or equivalent level of professional coding experience.

Skills: Requires oral and written communication skills necessary to interact and positively influence all organization levels both within and outside the clinic. Demonstrates ability to set and manage priorities. Demonstrates ability to work in a fast paced, detail oriented environment. Demonstrates flexibilty and ability to handle multiple priorities.

Experience: Minimum one year experience in medically related field;including customer service experience. Prior ICD-9 and CPT-4 coding experience. Proven verbal and written communication and presentation skills. Proven analytical abilities.

Preferred Qualifications: Proficient computer skills in Word/Word Perfect, Database applications, Powerpoint and Excel.

Shift

40 Hours / Day

About Us

Beth Israel Lahey Health is dedicated to improving health and wellness and making a difference in the lives of our patients, their families and all members of the communities we serve.  Formed in March 2019, Beth Israel Lahey Health is a patient-centered, integrated care delivery system providing a continuum of services spanning academic, tertiary and community hospitals, dedicated orthopedic and psychiatric hospitals, primary and specialty care, community acute care, ambulatory care, behavioral services and home health.  Beth Israel Lahey Health Performance Network is a unified joint contracting and population health management organization, jointly governed by participating physicians and hospitals.

Equal Opportunity Employer/Minorities/Females/Disabled/Veterans.