GENERAL SUMMARY/ OVERVIEW STATEMENT: Summarize the nature and level of work performed.Completes administrative functions associated with all prior authorization requirementsActs as a key contact to physicians, nurses, care team and patients for insurance questions and all aspects of access to careReceives denial and appeal requests and coordinates applicable information and formalizes payer appeals with practice clinical staffObtains detailed insurance benefit information for all aspects of treatment care planComputes liability estimates based on gaps in coverageWorks with practice clinical staff for drug grants and programs for inadequately insured patientsManages necessary insurance product needs, including Medicaid and other program enrollmentAttends appropriate practice meetingsAssist with front desk tasks as needed during vacationsAll other duties as assigned by Manager
The Patient Services Coordinator III, under general supervision, provides administrative support to health care providers within an ambulatory setting, and functions as a primary interface between the patient and the provider. This role is specifically designed to support the prior authorization functions of the practice.
This individual is part of an integrated care team that focuses on coordinating the financial aspect to patient care. The coordinator will work with patients and their families, beginning with an initial evaluation of insurance eligibility, coverage for treatment plan, financial liabilities, and prescription benefit coverage. Primary responsibilities include verification of insurance benefit eligibility, insurance pre-certification and authorization, verification of prescription benefits, analysis of insurance rejections, and writing payer appeals.
PRINCIPAL DUTIES AND RESPONSIBILITIES: Indicate key areas of responsibility, major job duties, special projects and key objectives for this position. These items should be evaluated throughout the year and included in the written annual evaluation.
The responsibilities of the Patient Services Coordinator III include and are not limited to the following:
SKILLS/ ABILITIES/COMPETENCIES REQUIRED: Must be realistic, objective, measurable and related to essential functions of this job.
- Must be able to provide excellent customer service
- Ability to communicate effectively and sensitively with patients, their families, and practice staff
- Must possess excellent organizational and prioritizing skills with the ability to multitask
- Ability to problem solve, work under pressure and under very tight deadlines
- Energetic team player with strong communication and interpersonal skills, positive attitude
- Must have adequate typing skills and be familiar with personal computers
- Bilingual in English and another language a plus
EDUCATION: Specify minimum education and clearly indicate if preferred or required
- Bachelor's degree, health related field (science, social work, e.g) preferred
EXPERIENCE: Specify minimum creditable years of experience and clearly indicate if preferred or required
- Excellent Customer Service Skills
- 5-7 years work in healthcare environment (preferred)
- Adequate computer, phone and typing skills
- Microsoft Word and Excel (preferred)
- Strong communication, interpersonal, team skills
- Knowledge of third party payers, government programs, insurance regulations, managed care contracting, medical terminology, and clinical considerations related to cancer care
- Knowledge of medical terminology and coding a plus
- Willingness to continually learn and grow as a member of a team and department
The right candidate is trustworthy, has a positive attitude, quick mind, and thrives while working under strict time-lines. We are looking for a fast learner of public third party payer regulations to ensure reimbursement so that MGH can continue to provide the highest quality of care in the industry for some of our most vulnerable citizens. We will gladly train the right candidate.EEO Statement
Massachusetts General Hospital is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. Applications from protected veterans and individuals with disabilities are strongly encouraged.