Billing Managed Care Coordinator - Urology Surgery

Responsible for obtaining insurance approval for all related activities for Brigham and Satellite operations, prior to initiation of patient services. Duties include verifying insurance eligibility, benefits and ensuring and/or reviewing referral reports to verify active referrals on file for each patient visit. Completing and (upon physician approval) physician treatment plans in their entirety and accurately to insurance companies in order to obtain financial clearance. Responsible for identifying and collecting payments for non-covered patient service revenue which includes but is not limited to past due balances, non-covered services; deductibles and coinsurance. Also responsible for correct and accurate posting in the billing system of collected patient service revenue. Explaining insurance coverage to patients, advising patients; requires detailed knowledge of insurance requirements and close attention to patient scheduled appointments since each insurance company has different requirements. Responsible for ensuring patients have signed self-pay waivers and contracts when appropriate, understand the refund process, the MGB billing model. Also responsible for ensuring signed documents are scanned into the electronic filing system. Responsible for explaining fee structures to patients for various treatment options and all other special programs. The Managed Care Coordinator is responsible for the centralized surgical billing calendar. Obtaining prior authorization for all surgeries on the PO side, as well as obtaining any facility authorizations the insurance company will provide. Responsible for handling all patients'' billing problems and inquiries, and working with and triaging to the MGB Billing, Compliance and Education team to resolve problems. Responsible for ensuring insurance referrals are received which may include working with the patient''s primary care physician or patient to obtain a referral, educating secretarial staff regarding which services are and are not covered by each insurance plan and which require a referral Receives and expedites all incoming/outgoing telephone calls in a professional and courteous manner. High level of communication required between clinical team, patient and MGB account management. May be responsible for registration duties including but not limited to reporting patient''s change in registration to the billing vendor and to BWH registration, as well as editing patient demographic and fiscal information. Performs cross-coverage duties, as necessary, for other Coordinators as well as the Managed Care Supervisor.Qualifications Customer service experience, required College degree, preferred - or years of equivalent experience will be considered 1-3 years'' experience in health care setting and extensive knowledge of 3rd party payers and billing requirements, preferred Excellent interpersonal skills Excellent written and oral communication skills Accuracy, with attention to detail Math/Financial experience Ability to work both independently and as part of a team Computer skills, including word processing and data entry Ability to work under pressure, multi-task and meet deadlines Familiarity with common office equipment

Created: 2025-11-15