Patient Services Coordinator III - MGH Cancer Center at Emerson Hospital

GENERAL SUMMARY / OVERVIEW STATEMENT:

The Patient Services Coordinator III assists the department with all components required for the daily operation of the ambulatory practice. Coordinating all aspects of administrative functions, they assist the department with the effective management of the practice’s daily operations and revenue enhancement. This position involves close interaction with physicians, clinical staff, members of the practice and patients of the Cancer Center.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

Relevant activities include, but are not limited to the following:

• Coordinates the scheduling of multiple appointments using multiple systems or resources.
• Coordinates and maintains provider’ master clinical schedules.
• Obtains intake information from patient and referring physician’s offices.
• Schedules radiology tests using multiple systems or resources.
• Orders and obtains scans for clinical sessions, pathology reports/slides, x-rays, x-ray reports, lab results.
• Works with Infusion Unit to coordinate chemotherapy treatments for patients.
• Performs reconciliation of daily schedule.
• Prepares visit summary reports for patients as applicable at checkout
• Triages and manages high volume of patient telephone calls, utilizing superb customer service skills.
• Obtains insurance precertification’s, authorizations, or referrals as required for radiology, genetic testing, chemotherapy/infusible or injectable medicines.
• Obtains detailed insurance benefit information for all aspects of infusion treatment care plan.
• Works with department clinical liaisons for inadequately insured patients
• Receives denial and appeal requests; coordinates applicable information and formalizes payer appeals with department clinical liaisons
• Works with Oncology Infusion Unit to identify potential payer issues prior to patient visit
• Investigates and resolves issues relating to and arising from the referral and/or billing process, which interrupts the delivery of care to a patient or the reimbursement for services rendered. Addresses patient questions, complaints and concerns.
• Functions as a resource for referral and insurance issues. Remains current on the changing issues impacting the health care insurers. Attends meetings as necessary.
• Possesses a thorough knowledge of all HMO, managed care, other third-party insurers, and available patient financial services/resources.
• Identifies and communicates to the Practice’s leadership issues of process creating inefficiencies within the operation. Assists in their resolution, working within the group and with management for the department as a whole.
• Coordinates the workflow and schedules within the practice to ensure an efficient daily operation. Troubleshoots workflow issues as needed, working with management to coordinate staffing and replacement coverage.
• Conducts or arranges for specific training for new PSC hires, while coordinating with the practice-training mentor.
• Maintains confidentiality and privacy, which is consistent with HIPAA guidelines.
• Assists with special projects as required. Projects may include such topics as obligations to insurers, hospital issues of compliance and/or operations improvement initiates.
• Provides cross-coverage for other practice staff members for absences, vacations, etc. and during variations in workflow, as needed.
• Performs other duties as assigned.

QUALIFICATIONS:

EDUCATION:

• High School Diploma, GED or equivalent
• Some college or Associate's Degree preferred

EXPERIENCE:

• Minimum of 3 years work experience in a medical group practice, billing, and/or managed care setting required.

SKILLS & COMPETENCIES REQUIRED:

• Demonstrated experience to interface with various levels of the practice, especially with the knowledge and issues related to manage care
• Demonstrated ability to work independently, with limited supervision, resolve issues, be organized, attentive to detail and achieve outcomes within the team
• Flexibility to handle multiple tasks and deadline pressures
• Must have ability to work in a fast-paced environment and manage competing demands effectively
• Requires a high level of empathy, compassion and confidentiality
• Excellent communication and interpersonal skills
• Effectively interacts with all levels of management
• Exceptional computer skills (Mosaiq, Epic, Microsoft Outlook, preferred)
• Demonstrates knowledge of HIPAA Confidentiality and Privacy policies

WORKING CONDITIONS:

• Office setting; ability to sit for 8 hours