Credit Resolution Specialist - Brigham and Women's Hospital

General summary/overview
Reporting directly to the Central Credit Resolution Manager and under the general direction of the Central Business Services Senior Manager, the Credit Resolution Specialist performs a variety of functions to insure the resolution of including but not limited to: self pay and third party credit balances accurately and in a timely manner. Participate as directed in the root cause analysis of credit creation. Identify issues and trends.

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Apply to: https://partners.taleo.net/careersection/jobdetail.ftl?job=3087133&lang=en

Posted 7/2/19

Contract Management Analyst - Brigham and Women's Hospital

General summary/overview

Reporting directly to the Manager, Payer Relations and under the general direction of the Director, Central Business Services, the Contract Management Analyst is primarily responsible for financial reporting, analysis and identification of over and under payments utilizing the BWPO’s contract management software.

The Contract Management Analyst must have a general understanding of the revenue cycle and be able to identify opportunities to improve overall billing performance or explain variances from estimates. Responsibilities include developing a dashboard management report focused on contractual payment performance, contract reimbursement trend analysis, identification of contract set-up issues and overall performance data. The Contract Management Analyst will be responsible for preparing summaries and reports for the BWPO Finance Department.

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Apply to: https://partners.taleo.net/careersection/jobdetail.ftl?job=3087206&lang=en

Posted 7/2/19

Payer Relations Analyst  - Brigham and Women's Hospital

General summary/overview

Reporting directly to the Manager, Payer Relations and under the general direction of the Director, Central Business Services, the Payer Relations Analyst will serve as the day to day contact for appointed contracted and non-contracted payers. The primary goal of the Analyst is to establish and maintain positive and effective working relationships with assigned payers aimed at improving communication, operational efficiencies and revenue. This individual will work closely with staff across all BWPO Departments, with payers, as well as within other PHS entities.

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Apply To: https://partners.taleo.net/careersection/jobdetail.ftl?job=3087138&lang=en

Posted 7/2/19

Billing & Compliance Manager - Reliant Medical Group

 

Position: Full time 40 hours per week

Hours: Monday through Friday 8:00am -4:30pm 

No Weekends, No Holidays 

Department: Revenue Operations Business Office 

Responsible for all aspects of coding, charge entry, coding denial follow up and the Reliant Billing Compliance Program.  Manages the daily activities and processes of assigned staff and the training, development and streamlining of policies and procedures and workflow,  monitoring staff productivity, quality of work and related duties. Communicates coding issues and initiatives with Revenue Operations, IT and Clinical Operations staff including Directors, Managers, Leads, Physicians and Allied Health Providers. Ensures Billing Compliance Policy, in line with Optum Compliance, is completed and communicated annually.

Responsibilities

Coding Responsibilities:

• Assures that coding and charge entry functions are performed accurately, efficiently and timely in accordance with regulations, department goals and carrier contracts as well as Corporate Targets and month end/year end requirements.
• Manages and maintains an efficient work process with an emphasis on automation and maximizing Epic Resolute Billing and clinical coding use of the EpicCare electronic health record (from a coding perspective).
• Integrates with Optum, all specified coding compliance data as required under Optum Coding Compliance Policies/Procedures.  Submits quarterly required reports to Optum Coding Compliance.
• Manages lag time from date of service to charge entry for all points of service.
• Measures and ensures staff productivity and accuracy within established standards
• Assures the coding and charge entry process system-wide is compliant with governmental and payer guidelines.
• Ensures that ICD, HCPCS and CPT coding are kept up-to-date and accurate. Works
• Collaboratively with coding staff and RMG IT Dept on yearly upload of ICD, CPT and HCPCS Codes
• Expands and improves on coding training and education sessions for the coding/charge entry staff, Revenue Operations staff and all RMG/SMG providers.
• Manages Coding related rejections/denials via Coding follow-up, ensuring that accounts receivable days are minimized and revenues are maximized.  Works collaboratively with payers to resolve outstanding coding related A/R concerns and improve processes.  Ensures timely accurate appeals and resolution of coding-related denials received from Insurance or governmental carriers.
• Collaborates with payors and with internal/external parties to resolve issues at a global level and expedite maximum reimbursement.  
• Collaborates with contracting to ensure accuracy and optimization of reimbursement and communication of contractual issues as they relate to coding compliance.

 

Billing Compliance Program:

• Manages Risk Adjustment (HCC) and Billing Compliance Auditors and associated Reliant program.  Develops team and integrates Reliant Billing Compliance Policy with Optum CCRA and other Optum auditing protocols.
• Active participant in the Reliant Compliance Steering Committee
• Acts as liaison for Optum CCRA (Coding Compliance Risk Analyzer) in both areas of Risk and Opportunity.
• Assists auditors with difficult/challenging compliance meetings and programs as well as corporate wide educational efforts.
• Ensures providers/clinical departments are notified of annual changes to CPT, ICD and HCPCS Code sets.

 

Coding and Billing Compliance:

• Keeps abreast of Coding/Reimbursement regulations, Billing Compliance regulations (HCC and General) and other industry guidelines and changes.  Communicates changes accordingly.
• Works closely with physicians, internal and external managers, administrators, team leaders and others to ensure that billing is optimized and is performed with-in regulatory guidelines.
• Creates and maintains efficient work processes with emphasis on automation and maximizing the use of the Billing System.  Tracks/Trends reasons for coding denials and audit failures and recommends/implements change to reduce volumes.
• Measures and ensures optimal staff productivity and accuracy.  Resolves discrepancies as required or directed.
• Monitors assigned staff work-queue volumes to ensure productivity and quality of work and to identify areas requiring re-allocation of resources.
• Meets with Clinical Operations, Managers, Team Leaders, Information Technology or others to ensure integration of revenue cycle and auditing activities.
• Participates as an active involved member of the Revenue Operations management team. Reports on a variety of trends and/or information as required or directed.
• Responds to administration and clinical department inquiries as required or directed.
• Ensures compliance with regulatory agencies such as DPH, etc.  Develops and maintains procedures necessary to meet regulatory requirement.
• Ensures that assigned area comply with clinic established policies, quality assurance programs, safety, and infection control policies and procedures.
• Ensures adequate equipment and supplies for assigned area.
• Ensures compliance to all health and safety regulations and requirements.
• Performs similar or related duties as required or directed.
• Regular, reliable and predicable attendance is required.

Qualifications

Bachelor’s Degree in Business Administration, Healthcare or related field.  Minimum of five (5) years health care Management experience in a multi-specialty physician group practice, billing agency or Hospital. Coding Certification required (CPC, CCS-P, etc.). CPMA is required. Demonstrated experience in professional billing environment/physician billing, reporting and revenue cycle including utilization of practice management systems and analytics. Demonstrated experience in Revenue Cycle Analytics. Must be proficient in use of Excel. Thorough knowledge of Medicare and Massachusetts third party payer requirements and billing compliance regulations. Understanding of Capitation and Global Risk Contracting Agreements/Billing.  Demonstrated knowledge of insurance rules and regulations and claims submission. Excellent interpersonal, organizational, and communication skills. Epic Resolute comprehension required within 12 months of start date.

Apply to: https://reliantmedicalgroup.org/careers/

Posted 6/21/19

Billing Compliance Auditor - Reliant Medical Group

 

Position: Full time 40 hours per week 
Hours: Monday through Friday 8:30am - 5:00pm 

No Weekends, No Holidays 

Department: Revenue Operations Business Office 

 

Responsible for performing internal coding audits and billing compliance reviews of various elements of physician billing for the organization.  Works within specified third party payer and federal (CMS) coding/billing regulations.   Develops training and education materials.  Provides training and education to providers, clinical department and Revenue Operations staff. Provides other internal billing-related compliance services to the organization as required. Measures coding trends as compared to national standards.

 

Responsibilities

Participates in the identification and resolution of areas requiring additional intervention through established Billing and Corporate Compliance work plans.    

Develops and implements clinic-wide training programs geared towards educating clinical and non-clinical support staff regarding compliance related topics and/or deficiencies identified through billing compliance audits.

 

• Develops and delivers clinic-wide memorandums/educational materials pertaining to relevant revenue integrity initiatives.
• Performs Hierarchal Condition Coding (HCC) reviews for Medicare Advantage program beneficiaries following established policy/procedure/process.  Identifies trends that result in lost HCC revenue and educates provider constituency as appropriate.
• Assists in the review and update of annual Revenue Integrity & Education work plan and audit schedule.
• Performs formal review of annual CPT/Diagnosis/HCPC changes and prepares educational documents by specialty highlighting significant changes.
• Trains providers, staff and others in small and large group sessions.
• Meets deadlines, productivity targets as defined in the Billing Compliance Work Plan.
• Communicates effectively at all levels in the organization, including clinical and non-clinical support staff, practice managers, physicians, and medical leadership.
• Conducts random and scheduled internal audits of physician billing and medical record documentation to ensure: Correct Coding (CPT, ICD-9, ICD-10, HCPCS, Modifiers), Accurate Data Entry, Accurate Charge Preparation/Processing, Compliance with governmental and third party billing regulations.
• Utilizes Microsoft Excel / Word, to document and report audit results to the appropriate personnel, including physicians/providers and Medical Leadership.
• Works collaboratively with clinical department physicians, mid-level providers and other staff to ensure appropriate and compliant documentation, coding and billing practices.
• Develops and tracks progress of internal audit schedules.
• Serves as an internal compliance resource for Patient Accounts, Clinical departments, and for coding and documentation questions.
• Utilizes the Internet, intranet, internal reference library, available workshops and/or seminars and other sources to stay current with government and local third party payer coding, specialty-specific and reimbursement rules and requirements.
• Measures and reports coding trends as compared to national standards; or claim/documentation reviews.  Documents and reports results to all appropriate parties.
• Monitors and reports productivity and other data as requested by manager.
• Participates in all governmental and third party insurance audits.
• Assists in developing Revenue Integrity and Education Policies and Procedures.
• Complies with health and safety requirements and with regulatory agencies such as DPH, etc.
• Complies with established departmental policies, procedures, and objectives.
• Enhances professional growth and development through educational programs, seminars, etc. 
• Maintains all Professional certifications.
• Attends a variety of meetings, conferences, and seminars as required or directed.
• Performs other similar and related duties as required or directed.
• Regular, reliable and predicable attendance is required.

Qualifications

BS in Health Related Field, or RN, LPN with experience.  Certified Professional Coder required (CPC, CCS-P, CCS, CPC-A, CPC-H). Three (3) to five (5) years experience in ICD-9/ICD-10, CPT and HCPCS coding. Experience with auditing physician medical records utilizing E+M guidelines. Utilize standard scoring (CMS) methodologies to report findings to providers. Ability to employ clinical reference with the auditing process. Apply CPT and ICD-9/ICD-10 coding convention to documentation guidelines. Apply CMS and other payer constraints to final code and documentation determination. Demonstrated experience in the application of medical terminology, anatomy and physiology or successful completion of related college course. Demonstrated experience in a physician/professional billing environment. Demonstrated experience with third party payer guidelines. Experience with Microsoft Office Suite (Excel, Word, Power Point) or successful completion of related course. Must show proficiency in current billing software within six (6) months.

Apply to: https://reliantmedicalgroup.org/careers/

Posted 6/21/19

Practice Administrator - Brigham and Women’s Health Care Center, Pembroke, MA

Full-time, Days

Brigham and Women's Harbor Medical Associates is part of the Brigham and Women's Physicians Organization and is a multispecialty, primary care practice with more than 65 physicians in our several offices on the South Shore.

You will find our practice culture stimulating and rewarding. We value all our employees and offer comprehensive benefits. We are affiliated with Brigham and Women's Hospital, Dana-Farber/Brigham and Women's Cancer Center and South Shore Hospital.

Opening September 3, 2019, the newly constructed Brigham and Women’s Health Care Center- Pembroke is looking for a dynamic leader with a flexible entrepreneurial spirit to coach and build a high- functioning, customer-focused team in this ambulatory health care center.  Each of our team members must embody a commitment to high quality patient care standards, a commitment to collaboration and teamwork, and a dedication to putting every patient first, every day.   In addition to the new Pembroke location the Practice Administrator will be responsible for the overall operations of the Scituate and Hingham Primary Care Locations. 

Brigham and Women’s Health Care Center- Pembroke is a non-licensed satellite owned by Brigham and Women’s Physician Organization.  In addition, the position oversees the BWPO South Shore Hingham, and Scituate Primary Care Locations.  The three locations comprise of approximately 100-125 fulltime and part time staff across multiple practices.  The Practice Administrator is responsible for the administrative and clinical operations of the centers, with direct supervisory responsibility for the practice Managers and RN Flow Manager (The RN Flow Manager will have a dotted-line to the Ambulatory Nursing Director) and is responsible for all staff at the Center.  All staff is employed by BWPO.

The Practice Administrator will serve as the primary contact for clinical and administrative operations at BWPO’s Pembroke, Hingham and Scituate sites. He or she will participate in the BWPO Pembroke planning process.  The Practice Administrator will participate in the move of the current Pembroke and Hanover offices to the new Pembroke location.  The Practice Administrator is responsible for the ramping up and stabilization of the new Pembroke location as well as the Hingham location that opened January 2, 2019.  The Practice Administrator will take ownership of the sites’ operating budget including resolving administrative and financial issues relating to all clinical operations; and leading the implementation of BWPO’s clinical and non-clinical processes to ensure an integrated, high quality patient experience.  Working in partnership with Director of Operations, the Practice Administrator is the “face of Pembroke, Scituate, and Hingham” in the community, ensuring that the Brigham Health mission of improving the health and wellness of the global and local community is embodied at each practice site. 

Qualifications:

• Bachelor’s degree required, Master’s Degree preferred.
• Minimum of 10 years of progressive experience in operations, project management, and/or healthcare management required; additional years of experience in healthcare financial management/ analysis preferred.
• Proven ability to build, lead, and retain high performing teams of diverse, multidisciplinary, multidisciplinary, multi departmental stakeholders at varied levels of academic and professional experience. 
• Proven track record of delivering outstanding customer service in a high-volume setting.
• Working experience in Massachusetts healthcare and/or similar academic medical center environment strongly preferred. 
• Excellent communication skills a must.
• A flexible, entrepreneurial, “can-do” attitude required.
• Applicable, general knowledge of: Human Resource Management; Financial systems, payroll, expense, and budget management; Strategic planning and implementation; Information systems; Quality improvement process management; General understating of reimbursement issues; and Trend analysis.

For a complete job description and to apply online: https://partners.taleo.net/careersection/jobdetail.ftl?job=3086220&lang=en#.XQO710LSZZQ.email

Brigham and Women’s Physicians Organization is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, creed, sex, sexual orientation, gender identity, national origin, ancestry, age, veteran status, disability unrelated to job requirements, genetic information, military service, or other protected status.

Posted 6/17/19

Practice Administrator

Job Title: Administrator

General Summary: Ob/Gyn practice on the South Shore is seeking an administrator that will be responsible for successfully managing and operating medical practice involving all sites.  Provides staff with the resources required to meet patient needs and meet the financial objectives of the group practice.  Reports directly to practice partners.

Primary Job Responsibilities: 

• 1.       Global oversight and implementation of goals of the practice.
• 2.       Develops/implements long-range plans.
• 3.       Manages the daily operations while developing, monitoring, and analyzing budget and financial information cost effectively.
• 4.       Oversees HR and ensures effective administration/implementation of compensation, benefits, job descriptions, personnel policies and payroll practices.
• 5.       Participates in the selection, training and supervision of all staff.
• 6.       Participates in staff supervision, performance evaluation, merit increases and disciplinary actions.
• 7.       Works with vendors to maintain clinical property, computer systems and installed software applications.
• 8.       Resolves administrative and operational problems.
• 9.       Ensures compliance with regulations and standards.
• 10.   Gathers and reports data for fiscal and statistical analysis.
• 11.   Coordinates with medical staff to ensure quality patient care and services are provided.
• 12.   Serves as a liaison between clinic and external agencies.
• 13.   Maintains the strictest confidentiality.

Education:  Master’s degree in health care administration, health administration

Experience:  Minimum 5 years executive-level experience including five years of experience in the administration of a health care organization.

Performance Requirements:

 Knowledge:

• 1.       Knowledge of practice management computer systems and applications.
• 2.       Knowledge of government and reimbursement regulations and requirements, specifically those of Medicare, Medicaid, managed care and other third party payor’s.

  Skills:

• 1.       Skill in exercising a high degree of initiative, judgement, discretion, and decision-making to achieve organizational objectives.
• 2.       Skill in planning, organizing, delegating and supervising.
• 3.       Skill in leading employees to accomplish all job objectives while inspiring confidence and motivation.
• 4.       Skill in verbal and written communication.

Abilities:

• 1.       Ability to assume responsibility and exercise authority over assigned work functions.
• 2.       Ability to foster teambuilding with all staff.
• 3.       Ability to research and prepare reports or other correspondence as required.
• 4.       Ability to competently use Microsoft Office, including Word, PowerPoint, Excel and appropriate practice management software.

Any interested candidates should send resumes to: resumes@southshorewomenshealth.com

Posted 5/13/19

Perfusionist - Cardiovascular Surgery 

Full-time position

Will be responsible for:

• Monitoring and controlling extracorporeal perfusion equipment during cardiopulmonary bypass surgery and related procedures on patients of all ages, while under the direction of a physician and in accordance with established policies, procedures and standards of practice.
• Selecting, assembling and preparing equipment and supplies for assigned cases.
• Operating and maintaining equipment.
• Monitoring and evaluating physiologic data and making adjustments in perfusion parameters as needed.
• Administering prescription drugs, blood products and anesthetic agents through the extracorporeal circuit and inducing specified physiologic conditions, such as hypothermia and circulatory arrest, as ordered by a physician.
• Assisting with inventory management.
• Assisting with assigned projects in a collaborative cardiovascular team.

To qualify, you must have:

• Graduated from an accredited Perfusion Training Program, with a Master’s or Bachelor’s degree preferred.
• Current certification as a Clinical Perfusionist by the American Board of Cardiovascular Perfusion.
• Perfusionist licensure through the Commonwealth of Massachusetts.
• Analytical skills to resolve complex problems requiring the use of scientific, mathematical, or technical principles and in depth, experienced based knowledge.
• The ability to communicate effectively both orally and in writing and provide empathy in difficult interpersonal situations.

Boston Children’s Hospital offers competitive compensation and unmatched benefits, including an affordable health, vision and dental insurance, generous levels of time off, 403(b) retirement savings plan, cash-value pension plan, tuition reimbursement, and discounted rates on T-passes (50% off). Discover your best.

Boston Children’s Hospital is an Equal Opportunity / Affirmative Action Employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, national origin, sex, sexual orientation, gender identity, protected veteran status or disability.

Apply to: https://jobs.brassring.com/1033/ASP/TG/cim_jobdetail.asp?partnerid=368&siteid=5205&Areq=50051BR

Posted 4/18/19