Patient Business Representative (PBR) at Southern Jamaica Plain Health Center plays a major role not only to the health center but to the community we serve with functions as a financial counselor and registrar. The PBR is responsible for the in-depth evaluation of financial history for both uninsured and underinsured patients for the purpose of determining eligibility for government and pharmacy financial assistance programs. The PBR will report directly to the Supervisor of Managed Care. The 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. The PBR will work collaboratively with Practice Management and staff/providers, Patient Accounts, Patient Service Center, BWH Customer Service/Billing, Patient Relations, Billing Agencies, the Office of General Counsel, and State Agencies, e.g., EOHHS, DHCFP, etc. The PBR will work closely with BWH/BWPO/MGB to make sure patients can receive equitable care needed.

• Responsible for screening patients for MassHealth, CarePlus, Connector Care, Health Safety Net, Medicare and assisting in the application process when appropriate. Submits all Massachusetts applications for health coverage via the Health Connector.
• 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 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.
• Educate and refer patients for all other assistance programs such as SNAP, housing, and other SDOH resources.
• Assists patients in applying for disability and long-term care Medicaid, dual-eligible support and enrollment.
• Assists in full registration process, ensuring accurate guarantor accounts and update any account when necessary. Adheres to all registration policies to assure effective operations.
• Re-bill accounts when necessary for the Hospital and BWPO.
• Directly interfaces with billing agencies to investigate patient reported issues and maintains a contact list.
• Utilizes knowledge of various payer requirements and when necessary, research any billing inquiries initiated by the patient and provide a comprehensive and comprehendible explanation to the patient and or practice.
• Reviews visit notes/codes against what was entered in EPIC, patient medical record 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.
• Reviews and resolves registration related billing issues such as redirecting to third party guarantor account.
• Fosters a positive relationship with assigned practice management and staff, shares relevant findings, and enhances understanding of patient concerns.
• Works on special projects, REAL/SOGI data collection with MGB; No Show Equity Project, etc, and cover other services and/or locations, and other task when necessary
• Supports with administrative functions as needed including front desk and main phone line coverage
• Responsible for processing out of network prior authorizations for radiology and other procedures
• According to procedure, runs the daily DAR report to scrub for insurance discrepancies, including self-pay accounts and responsible for calling patients three days prior to scheduled appointment to update all registration and insurance information.
• Performs other duties as assigned

• Bachelor's degree or equivalent relevant experience required
• Certified Applications Counselor (CAC)
• SHINE Certification preferred
• Prior experience with 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