Job Profile Summary 

​This role focuses on activities related to revenue cycle operations such as billing, collections, and payment processing.  In addition, this role focuses on performing the following Patient Access duties: Performs the administrative and financial-clearance duties necessary to facilitate the procurement of clinical services by patients. Collects patient's necessary demographic and financial information from physician offices, acute-care entities, or the patients themselves, schedules services for patients, and handles referrals from primary care doctors to ensure patients are scheduled for recommended appointments/procedures, etc.    An organizational related support or service (administrative or clerical) role or a role that focuses on support of daily business activities (e.g., technical, clinical, non-clinical) operating in a “hands on” environment.  The majority of time is spent in the delivery of support services or activities, typically under supervision.  An entry level role that typically requires little to no prior knowledge or experience, work is routine or follows standard procedures, work is closely supervised, and communicates information that requires little explanation or interpretation. 

Job Overview 

This position coordinates all tasks associated with incoming consultation referrals from physician practices, hospitals and other healthcare facilities, as well as all benefit and referral management and medical record request management. Serves as the patient’s point of contact for medical insurance and financial counseling.  The position will also report back to the multidisciplinary team. 

Job Description 

Minimum Qualifications: 

1. High school diploma or equivalent. 

2. Two (2) years of related experience in insurance, managed care referral processes, private physician’s office practice or hospital registration setting. 

Preferred Qualifications: 

1. Bachelor’s degree. 

2. Three (3) years of related experience in insurance, managed care referral processes, private physician’s office practice or hospital registration setting. 

3. MassHealth Certified Application Counselor. 

Duties and Responsibilities: The duties and responsibilities listed below are intended to describe the general nature of work and are not intended to be an all-inclusive list.  Other duties and responsibilities may be assigned. 

1. Coordinates all incoming referrals for consultations from physician practices, hospitals, nursing homes and other healthcare facilities. 

2. Compiles all clinical data, including physician notes, patient history, laboratory and imaging results and other clinical information necessary from referring physician or facility.    

3. Arranges and schedules consultation appointments with patients, confirming demographic information and verifying insurance payor eligibility.   

4. Verifies insurance, checks benefits, obtains patient responsibility from payer, etc.   

5. Meets with the patient and family during the interdisciplinary introduction meetings to review the patient’s insurance(s), insurance coverage, out-of-pocket costs, etc.   

6. Serves as patient liaison for financial matters throughout treatment, including following up on insurance and financial risk assessment every quarter. 

7. Collects patient responsibility pre-service.  Establishes payment plan, if necessary. 

8. Completes, files, and follows to resolution applications for Massachusetts Medicaid, including disability, Health Safety Net, and other such programs.  

9. Refers patients to programs where Hospital staff cannot file directly for the patient, including Veteran's Services, and EAEDC. 

10. Works closely with and communicates consistently with Social Work, Case Management, Billing, and Contracting to provide a cohesive support system to the patient and the clinical providers. 

11. Stays abreast of regulations, making certain that applications are appropriate and complete to ensure that the Hospital, the professional groups, and the patient receive all benefits for which the patient is eligible.  

12. Documents all meeting minutes and steps taken on an account.   

13. Processes all medical record requests from patients, insurance companies, attorneys, etc. Informs request of fee, if applicable, and ensure payment received prior to record released.   

14. Requests and obtains insurance referral from referring physician or patient’s primary care physician.  

15. Sends all pre-visit paperwork to patient with clear instructions. 

16. Assists patient with maximizing insurance benefits. 

Physical Requirements:  

1. Occasionally lift and/or move up to 25 lbs. 

2. This is largely a sedentary role, which involves sitting most of the time, but may involve movements such as walking, standing, reaching, ascending/descending stairs and operating office equipment. 

3. Frequently required to speak, hear, communicate and exchange information. 

4. Ability to see and read computer displays, read fine print, and/or normal type size print and distinguish letters, numbers and symbols. 

5. There are some occasions when patients are on precautions and a gown and mask must be worn when interviewing. 

6. There are some situations when patients may be violent and the correct approach is invaluable, when trying to extract financial information. 

Skills & Abilities: 

1. In-depth knowledge of medical terminology and its relationship in establishing certifiable disabilities.  

2. Excellent interpersonal skills required to interact effectively with patients, their families, the medical staff, QSS, and other departments within the facility, as well as many outside agencies.  

3. Ability to grasp, retain, and apply new regulations and procedural changes both within the institution and to outside agencies.  

4. Understanding in the application of health insurance benefits to hospital and professional charges.  

5. Ability to handle stressful situations involving critically ill patients and other sensitive issues which involve finances.  

6. Good written communication skills.  

7. Excellent systems skills. 

8. Ability to work in a complex systems environment and understand spreadsheets and other business technologies.