Full-time 40 hours, days

The Patient Business Representative (PBR) reports directly to the Manager of Patient Financial Services. 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 Patient Business Representative (PBR) 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 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 will work collaboratively with BWFHPO Practice Management, Patient Accounts, BWFH Customer Service, Patient Relations, BWFHO Billing Agencies, the Office of General Counsel, and State Agencies, e.g., EOHHS, DHCFP, etc.

Principal Duties and Responsibilities:

Financial Assistance

• Responsible for screening patients for MassHealth, CarePlus, Connector Care, and Health Safety Net, assisting in the application process when appropriate. Submits applications all Massachusetts applications for health coverage via the Health Connector.
• The PBR will keep track of all cases using ONTRAC as well as a paper tickle file system. The PBR will also assist with out of state applications when appropriate.
• 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.
• Assists patients in applying for pharmaceutical assistance programs (PAP), acting as liaison between PAP representatives and the patient or physician office.
• Assists Medicare patients in applying for Low Income Subsidy for Medicare Part D and for assisting patients in navigating the Medicare Part D website to choose a plan.
• Assists patients in applying for and/or understanding all other financial assistance programs or low-cost insurance plans 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 or Special Circumstances or the PHS Financial Assistance application.
• Assists patients in applying for Social Security, WIC, Fuel Assistance, etc.
• Assists patients in applying for disability and long-term care Medicaid.

Billing/Payment/Registration

• Acts as a liaison between the patients, hospital billing department and BWFHPO practices/billing agencies in addressing any billing related inquires and issues.
• 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.
• Re-bill accounts when necessary for the Hospital and BWFHPO.
• Directly interfaces with billing agencies in order 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 comprehendible explanation to the patient and or practice.
• Reviews visit notes/codes against what was entered in EPIC and ONTRAC to determine if an incorrect code was entered. Communicates with practice/physician to resolve problems regarding coding/billing issues.
• Investigates managed care related issues with the payer and the Patient Service Center.
• Works to resolve collection disputes, collect payments from patients and post payments in EPIC Accounts Receivable System and PeopleSoft Cash Management
• Reviews and resolves registration related billing issues.
• Fosters a positive relationship with assigned practice management, shares relevant findings, and enhances understanding of patient concerns.
• Maintains a daily workflow queue of patient and practice billing issues and their outcome in ONTRAC.
• Assists in registration process and update any account when necessary. Adheres to all registration policies to assure effective operations.
• Help patients apply for and or understand all other financial assistance programs such as INET’s Medical Hardship or Special Circumstances or the PHS Financial Assistance application.
• Assists patients in applying for Social Security, WIC, Fuel Assistance, etc.
• Assists patients in applying for disability and long-term care Medicaid.
• Works on special projects, cover other services and/or locations, and other task when necessary.

• Bachelor’s degree or equivalent relevant experience required
• Certified Applications Counselor (CAC)
• Prior experience with patient financial assistance or Government related programs preferred
• Knowledge of medical terminology helpful
• Familiarity with a hospital legacy system, Microsoft Office and Share Point preferred
• Bilingual preferred

Skills/Abilities/Competencies
• Demonstrated excellent customer service abilities
• Proficiency in oral and written communication
• Certified Applications Counselor (CAC)
• Adeptness in assessing and solving problems, excellent organizational skills, ability to prioritize
• Knowledge of revenue cycle particularly with regard to insurance reimbursement and managed care referral requirements
• Ability to effectively interact with various levels of the organization
• Ability to work independently, with minimal supervision

Brigham and Women’s Faulkner Hospitalis an Affirmative Action Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. 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, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.