Brigham and Women's Hospital
Team Lead Patient Access Representative
Brigham and Women's Hospital, Boston, Massachusetts, us, 02298
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Pay found in job post Retrieved from the description.
Base pay range $21.78/hr - $31.08/hr
Site: The Brigham and Women's Hospital, Inc.
Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.
Job Summary Team Lead reports directly to the Practice Manager. The Team Lead, under the direction of the Manager, is responsible for all the responsibilities of the Patient Business Representative positions. The PBR functions as a financial counselor and registrar and is responsible for the in‑depth evaluation of financial history for both uninsured and underinsured patients for determining eligibility for government and pharmacy financial assistance programs.
The Team Lead will serve as the primary practice contact when patients require assistance with various billing/financial related issues, which cannot otherwise be resolved by the Practice Service Representative.
The PBR Team Lead will have a strong working knowledge of all aspects of the billing/revenue cycle, managed care requirements, coding and compliance. Utilizing a variety of available resources and contacts the counselor will assess and work towards the resolution of identified patient fiscal issues.
The PBR Team Lead will work collaboratively with BWPO Practice Management, Patient Accounts, BWH Customer Service, Patient Relations, BWPO Billing Agencies, the Office of General Counsel, and State Agencies, e.g., EOHHS, DHCFP, etc.
In addition, the Patient Business Representative Team Lead will act as a Department resource, which may include assisting in the training of new hires, or the retraining of existing hires.
The PBR Team Lead will act as lead for teams, as assigned, which can vary.
The PBR Team Lead will assist the Management team in projects as necessary and assigned.
Qualifications Provide directions and guidance.
Organizing tasks and setting goals.
Training team members, setting strategy and monitoring performance progress towards goals.
Collaborate with management to discover training needs and assist with coaching.
Assist with solving problems and resolving conflicts.
Works projects related to the Inpatient Accounts Department when assigned.
Assists in the review of staff denials when assigned.
Acts as a subject matter expert for the department, and may be asked to participate in meetings, as necessary.
Perform daily staff audits and assist with overseeing the day‑to‑day workflow operations.
Work to create an inspiring team environment with an open communication culture.
Interview patients in person and on the telephone in a professional manner that results in positive patient relations and prompt reimbursement for the hospital. Provide guidance, direction and assistance to patients.
Verifies and/or collects demographic and financial information on all scheduled visits. Enters/edits data online as needed, ensuring its accuracy and integrity.
Achieve and maintain mandatory ongoing department training and certification designation as Certified Application Counselor (CAC).
Contacts insurance companies, managed care plans and outside agencies to verify insurance coverage and benefits.
Respond to department email and phone calls for requests for services through the day. Document patient and request in FAM for tracking and follow‑up.
Responsible for screening patients for MassHealth, CarePlus, Connector Care, Health Safety Net and Qualified Health Plans (QHP), assisting in the application process when appropriate. Submit applications for all Massachusetts applicants for health coverage via the Health Connector online using the Assistant Portal, paper by fax or by phone when required.
Maintains ongoing communication with government agencies regarding the status of claims, following up with patients as necessary to obtain required documentation to ensure that the state gets the info needed to process the applications in a timely manner.
Keep track of all cases using FAM, paper ticket file system and keep a daily productivity log sheet when necessary.
Acts as patient representative in any cases submitted via the Health Connector, paper or over the phone, assisting the patient in deciphering notices received from EOHHS. Assists patients in the redetermination process for MassHealth, Connector Care and or Health Safety Net.
Assist with choosing a plan for Medicare Part D and Low‑Income Subsidy for Medicare Part D.
Assists in processing out‑of‑network Prior Authorizations, when needed.
Assists patients in applying for and/ or understanding all other financial assistance programs such as the Insurance Partnership, Medical Security Plan, and Health Connector Plans.
Help patients apply for and or understand all other financial assistance programs such as INET’s Medical Hardship, Special Circumstances or the PHS Financial Assistance application.
Submit and complete disability and long‑term care Medicaid applications.
Acts as a liaison between the patients, hospital billing department and BWPO practices/billing agencies in addressing any billing related inquiries and issues.
Create and provide estimates to patient, practice or insurance company. Accepts and/or arranges payment for deductibles and outstanding balances utilizing Chapter 224 Patient Estimations Policy and Procedure. Counsels and advises patients of discount options available according to Partners guidelines.
Works to resolve collection disputes, collect payments from patients and post payments in EPIC Accounts Receivable System.
Collect, Post and reconcile payment for services and secures cash drawer according to departmental procedures.
Re‑bill accounts when necessary for the Hospital and BWPO.
Directly interfaces with billing agencies to investigate patient reported issues and maintains a contact list.
Utilizes knowledge of various payer requirements and when necessary researches any billing inquiries initiated by the patient and is able to provide a comprehensive and comprehensible explanation to the patient and/or practice.
Investigates MCO and ACO issues. Review visit notes/codes against what was entered in EPIC with RTE or another verification system to determine if an incorrect code was entered. Communicates with practice/physician to resolve problems regarding coding/billing issues.
Fosters a positive relationship with assigned practice management, shares relevant findings, and enhances understanding of patient concerns.
Enter billing issues in FAM for resolution.
Works on special projects, cover other services and/or locations, and other tasks when necessary.
Reviews and follows up on all scheduled patient appointments within 24 hours at the latest, to identify and minimize financial risk to the institution.
Maintains patient confidentiality and privacy by accessing patient information only to the extent necessary to fulfill assigned duties. All patient information must be kept private, confidential and secure. All lists, reports, files and documents must always be properly secured and stored. Interviews and examinations should be conducted in such a manner as to afford the patient reasonable audio and visual privacy.
Maintains effective working relationships and communicates regularly with providers and other departments to update and exchange pertinent account information.
Adheres to Customer Service Standards by demonstrating professionalism, alertness, helpfulness, and receptiveness to all patients, visitors and other staff members.
Employs discretion when leaving answering machine messages or sending faxes. Supports team manager and performs management duties when manager is absent or out of office. Assists management with hiring processes and new team member training. Assist management with weekly and monthly progress reporting, tracking progress, monitoring team members’ tasks, and ensuring deadlines are met also are functions of a team leader. Answers team member questions, helps with team member problems, and oversees team member work for quality and guideline compliance. Assists with new patient registration in Epic.
QUALIFICATIONS
Bachelor’s degree or equivalent preferred; high school diploma required.
Proven experience in a similar setting is acceptable in lieu of educational requirements.
3-5 years’ experience in a hospital setting, experience with prior authorizations, billing and reimbursement helpful.
Certified Applications Counselor (CAC).
Familiarity with a hospital legacy system, Microsoft Office and SharePoint preferred.
Prior experience with patient financial assistance or government related programs preferred.
Knowledge of medical terminology helpful.
Bilingual preferred.
Interpersonal relationship skills necessary to communicate effectively with patient/family, physicians and their support staff, medical staff, nursing staff, other hospital personnel and many external organizations and agencies.
The technical knowledge of specific legal and regulatory requirements and an understanding of complex third party and medical assistance policies and procedures.
Knowledge of the hospital information system with emphasis on accounts receivables programs.
Ability to function independently and prioritize work within established policies.
Certified Applications Counselor (CAC).
Requires good judgment, tact, sensitivity and the ability to function in a stressful environment.
Ability to maintain confidentiality regarding the patients, their medical histories, demographic and fiscal information, etc.
Additional Job Details Physical Requirements
Standing Occasionally (3-33%)
Walking Occasionally (3-33%)
Sitting Constantly (67-100%)
Lifting Occasionally (3-33%) 20lbs - 35lbs
Carrying Occasionally (3-33%) 20lbs - 35lbs
Pushing Rarely (Less than 2%)
Pulling Rarely (Less than 2%)
Climbing Rarely (Less than 2%)
Balancing Occasionally (3-33%)
Stooping Occasionally (3-33%)
Kneeling Rarely (Less than 2%)
Crouching Rarely (Less than 2%)
Crawling Rarely (Less than 2%)
Reaching Occasionally (3-33%)
Gross Manipulation (Handling) Constantly (67-100%)
Fine Manipulation (Fingering) Frequently (34-66%)
Feeling Constantly (67-100%)
Foot Use Rarely (Less than 2%)
Vision - Far Constantly (67-100%)
Vision - Near Constantly (67-100%)
Talking Constantly (67-100%)
Hearing Constantly (67-100%)
Remote Type Hybrid
Work Location 640 Centre Street
Scheduled Weekly Hours 40
Employee Type Regular
Work Shift Day (United States of America)
Pay Range $21.78 - $31.08/Hourly
Grade 4
Benefits At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.
EEO Statement The Brigham and Women’s Hospital, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the application or interview processes and to perform essential job functions. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974 and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation may contact Human Resources at (857)‑282‑7642.
Mass General Brigham Competency Framework At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People‑Focused, half Performance‑Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success.
Seniority Level Mid‑Senior level
Employment Type Full‑time
Job Function Health Care Provider
Industries Hospitals and Health Care
Referrals increase your chances of interviewing at Brigham and Women’s Hospital by 2x
Boston, MA $185,000.00-$195,000.00 1 month ago
Patient Experience Representative - MSICU: 11pm-7:30am Sun-Thurs Patient Experience Representative I- Ophthalmology Patient Experience Representative (3:00pm-11:30pm) We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
#J-18808-Ljbffr
Get AI-powered advice on this job and more exclusive features.
Pay found in job post Retrieved from the description.
Base pay range $21.78/hr - $31.08/hr
Site: The Brigham and Women's Hospital, Inc.
Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.
Job Summary Team Lead reports directly to the Practice Manager. The Team Lead, under the direction of the Manager, is responsible for all the responsibilities of the Patient Business Representative positions. The PBR functions as a financial counselor and registrar and is responsible for the in‑depth evaluation of financial history for both uninsured and underinsured patients for determining eligibility for government and pharmacy financial assistance programs.
The Team Lead will serve as the primary practice contact when patients require assistance with various billing/financial related issues, which cannot otherwise be resolved by the Practice Service Representative.
The PBR Team Lead will have a strong working knowledge of all aspects of the billing/revenue cycle, managed care requirements, coding and compliance. Utilizing a variety of available resources and contacts the counselor will assess and work towards the resolution of identified patient fiscal issues.
The PBR Team Lead will work collaboratively with BWPO Practice Management, Patient Accounts, BWH Customer Service, Patient Relations, BWPO Billing Agencies, the Office of General Counsel, and State Agencies, e.g., EOHHS, DHCFP, etc.
In addition, the Patient Business Representative Team Lead will act as a Department resource, which may include assisting in the training of new hires, or the retraining of existing hires.
The PBR Team Lead will act as lead for teams, as assigned, which can vary.
The PBR Team Lead will assist the Management team in projects as necessary and assigned.
Qualifications Provide directions and guidance.
Organizing tasks and setting goals.
Training team members, setting strategy and monitoring performance progress towards goals.
Collaborate with management to discover training needs and assist with coaching.
Assist with solving problems and resolving conflicts.
Works projects related to the Inpatient Accounts Department when assigned.
Assists in the review of staff denials when assigned.
Acts as a subject matter expert for the department, and may be asked to participate in meetings, as necessary.
Perform daily staff audits and assist with overseeing the day‑to‑day workflow operations.
Work to create an inspiring team environment with an open communication culture.
Interview patients in person and on the telephone in a professional manner that results in positive patient relations and prompt reimbursement for the hospital. Provide guidance, direction and assistance to patients.
Verifies and/or collects demographic and financial information on all scheduled visits. Enters/edits data online as needed, ensuring its accuracy and integrity.
Achieve and maintain mandatory ongoing department training and certification designation as Certified Application Counselor (CAC).
Contacts insurance companies, managed care plans and outside agencies to verify insurance coverage and benefits.
Respond to department email and phone calls for requests for services through the day. Document patient and request in FAM for tracking and follow‑up.
Responsible for screening patients for MassHealth, CarePlus, Connector Care, Health Safety Net and Qualified Health Plans (QHP), assisting in the application process when appropriate. Submit applications for all Massachusetts applicants for health coverage via the Health Connector online using the Assistant Portal, paper by fax or by phone when required.
Maintains ongoing communication with government agencies regarding the status of claims, following up with patients as necessary to obtain required documentation to ensure that the state gets the info needed to process the applications in a timely manner.
Keep track of all cases using FAM, paper ticket file system and keep a daily productivity log sheet when necessary.
Acts as patient representative in any cases submitted via the Health Connector, paper or over the phone, assisting the patient in deciphering notices received from EOHHS. Assists patients in the redetermination process for MassHealth, Connector Care and or Health Safety Net.
Assist with choosing a plan for Medicare Part D and Low‑Income Subsidy for Medicare Part D.
Assists in processing out‑of‑network Prior Authorizations, when needed.
Assists patients in applying for and/ or understanding all other financial assistance programs such as the Insurance Partnership, Medical Security Plan, and Health Connector Plans.
Help patients apply for and or understand all other financial assistance programs such as INET’s Medical Hardship, Special Circumstances or the PHS Financial Assistance application.
Submit and complete disability and long‑term care Medicaid applications.
Acts as a liaison between the patients, hospital billing department and BWPO practices/billing agencies in addressing any billing related inquiries and issues.
Create and provide estimates to patient, practice or insurance company. Accepts and/or arranges payment for deductibles and outstanding balances utilizing Chapter 224 Patient Estimations Policy and Procedure. Counsels and advises patients of discount options available according to Partners guidelines.
Works to resolve collection disputes, collect payments from patients and post payments in EPIC Accounts Receivable System.
Collect, Post and reconcile payment for services and secures cash drawer according to departmental procedures.
Re‑bill accounts when necessary for the Hospital and BWPO.
Directly interfaces with billing agencies to investigate patient reported issues and maintains a contact list.
Utilizes knowledge of various payer requirements and when necessary researches any billing inquiries initiated by the patient and is able to provide a comprehensive and comprehensible explanation to the patient and/or practice.
Investigates MCO and ACO issues. Review visit notes/codes against what was entered in EPIC with RTE or another verification system to determine if an incorrect code was entered. Communicates with practice/physician to resolve problems regarding coding/billing issues.
Fosters a positive relationship with assigned practice management, shares relevant findings, and enhances understanding of patient concerns.
Enter billing issues in FAM for resolution.
Works on special projects, cover other services and/or locations, and other tasks when necessary.
Reviews and follows up on all scheduled patient appointments within 24 hours at the latest, to identify and minimize financial risk to the institution.
Maintains patient confidentiality and privacy by accessing patient information only to the extent necessary to fulfill assigned duties. All patient information must be kept private, confidential and secure. All lists, reports, files and documents must always be properly secured and stored. Interviews and examinations should be conducted in such a manner as to afford the patient reasonable audio and visual privacy.
Maintains effective working relationships and communicates regularly with providers and other departments to update and exchange pertinent account information.
Adheres to Customer Service Standards by demonstrating professionalism, alertness, helpfulness, and receptiveness to all patients, visitors and other staff members.
Employs discretion when leaving answering machine messages or sending faxes. Supports team manager and performs management duties when manager is absent or out of office. Assists management with hiring processes and new team member training. Assist management with weekly and monthly progress reporting, tracking progress, monitoring team members’ tasks, and ensuring deadlines are met also are functions of a team leader. Answers team member questions, helps with team member problems, and oversees team member work for quality and guideline compliance. Assists with new patient registration in Epic.
QUALIFICATIONS
Bachelor’s degree or equivalent preferred; high school diploma required.
Proven experience in a similar setting is acceptable in lieu of educational requirements.
3-5 years’ experience in a hospital setting, experience with prior authorizations, billing and reimbursement helpful.
Certified Applications Counselor (CAC).
Familiarity with a hospital legacy system, Microsoft Office and SharePoint preferred.
Prior experience with patient financial assistance or government related programs preferred.
Knowledge of medical terminology helpful.
Bilingual preferred.
Interpersonal relationship skills necessary to communicate effectively with patient/family, physicians and their support staff, medical staff, nursing staff, other hospital personnel and many external organizations and agencies.
The technical knowledge of specific legal and regulatory requirements and an understanding of complex third party and medical assistance policies and procedures.
Knowledge of the hospital information system with emphasis on accounts receivables programs.
Ability to function independently and prioritize work within established policies.
Certified Applications Counselor (CAC).
Requires good judgment, tact, sensitivity and the ability to function in a stressful environment.
Ability to maintain confidentiality regarding the patients, their medical histories, demographic and fiscal information, etc.
Additional Job Details Physical Requirements
Standing Occasionally (3-33%)
Walking Occasionally (3-33%)
Sitting Constantly (67-100%)
Lifting Occasionally (3-33%) 20lbs - 35lbs
Carrying Occasionally (3-33%) 20lbs - 35lbs
Pushing Rarely (Less than 2%)
Pulling Rarely (Less than 2%)
Climbing Rarely (Less than 2%)
Balancing Occasionally (3-33%)
Stooping Occasionally (3-33%)
Kneeling Rarely (Less than 2%)
Crouching Rarely (Less than 2%)
Crawling Rarely (Less than 2%)
Reaching Occasionally (3-33%)
Gross Manipulation (Handling) Constantly (67-100%)
Fine Manipulation (Fingering) Frequently (34-66%)
Feeling Constantly (67-100%)
Foot Use Rarely (Less than 2%)
Vision - Far Constantly (67-100%)
Vision - Near Constantly (67-100%)
Talking Constantly (67-100%)
Hearing Constantly (67-100%)
Remote Type Hybrid
Work Location 640 Centre Street
Scheduled Weekly Hours 40
Employee Type Regular
Work Shift Day (United States of America)
Pay Range $21.78 - $31.08/Hourly
Grade 4
Benefits At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.
EEO Statement The Brigham and Women’s Hospital, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the application or interview processes and to perform essential job functions. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974 and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation may contact Human Resources at (857)‑282‑7642.
Mass General Brigham Competency Framework At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People‑Focused, half Performance‑Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success.
Seniority Level Mid‑Senior level
Employment Type Full‑time
Job Function Health Care Provider
Industries Hospitals and Health Care
Referrals increase your chances of interviewing at Brigham and Women’s Hospital by 2x
Boston, MA $185,000.00-$195,000.00 1 month ago
Patient Experience Representative - MSICU: 11pm-7:30am Sun-Thurs Patient Experience Representative I- Ophthalmology Patient Experience Representative (3:00pm-11:30pm) We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
#J-18808-Ljbffr