Global Medicine Business Operations Coordinator

SHIFT:

• Prepares, reviews and audits reporting for Global Medicine data sources, including but not limited to Epic and Salesforce.
• Leads daily operations of global patient financial clearance process.
• Researches and works on problem accounts and issues with Payers and the Specialty Billing Office.
• Works to identify and implement opportunities for increased communication and efficiency.
• Attends meetings and represents the Financial Clearance Team and Global Medicine Department as needed.
• Attends and presents upcoming and current patients for discussion at bi-weekly Financial Clearance Team meetings.
• Leads weekly clinical huddles.
• Performs ongoing analysis of expected versus actual patient charges and utilizes data to better estimate costs to future patients.
• Keeps Manager abreast of all financial clearance and customer service issues while identifying potential contingency plans.
• Assists in compiling departmental statistics.
• Provides support and training to staff to ensure the daily workflow and objectives are met.
• Serves as point of contact for all CHOP Departments.
• Provides regular communication to internal partners regarding the financial status of Global patients.
• Collaborates with Specialized Billing Office, Case Management and Bed Management to identify and process Global patients Completes all tasks within timelines given as assigned by Manager.
• Other duties as assigned.
• Reviews Global Insurance patients' coverage, benefits, authorization requirements and financial responsibility. Communicates coverage, benefits and financial responsibly to patient. Obtains required authorization prior to services being provided.
• Initiates and obtains authorization for Global patients' medical care and treatment including, but not limited to surgical, medical, and high imaging radiology services.
• Reviews diagnosis/procedure codes to ensure they are documented correctly and accurately to reflect the clinical treatment plan of services to be performed.
• Identifies and provides pertinent medical notes needed to complete authorization process.
• Notifies clinical coordinator/physician office/hospital of authorization issues, denials, or requests for additional clinical information and/or peer to peer reviews.
• Prioritizes daily work load based on date of service, insurance carrier requirements, unexpected date changes or urgent requests, while processing request within departmental expectations.
• Effectively communicates the medical services to be rendered and previous medical history.
• Discusses, interprets and sends pertinent medical history to complete authorization process.
• Works collaboratively with Global Patient Services Clinical Coordinator that follows the financial and medical status of complex medical cases until treatment is complete
• Coordinates with divisions to aid in timely completion and submission of authorizations and treatment plans.
• Converts common diagnosis descriptions to numeric ICD 10 or CPT codes.
• Documents all communication and authorizations accurately and completely in EPIC and Salesforce.
• Maintains Epic and Salesforce registration, coverage and billing information to ensure timely billing and reimbursement.
• Aids in the collaboration with physician offices and third party payers concerning contract exclusion and/or denials.
• Stays abreast of changing third party payer criteria to aid in revenue capture as it relates to hospital financial policy.
• Develop Cost Estimates for highly complex Global Self-Pay cases and others as requested.
• Works cooperatively with Clinical Coordinator and divisions to aid in securing treatment plans and like-patients in a timely manner.
• Works with Clinical Coordinator to identify relevant patient comparison data based on target patient's complex and specific treatment plan.
• Analyzes like-patient charge data for outliers and other anomalies.
• Utilizes data analytic resources as necessary to identify relevant like-patients.
• Ensures correct discount rates are provided when appropriate.
• Sends Financial Agreements to families and ensures that Agreements are signed, returned and documented.
• Ensures that full prepayment is received prior to scheduling of medical appointments.
• Monitors and documents in Salesforce all patient wire transfer/credit card transactions.
• Maintains catalog of cost estimates in the department's CRM tool.
• Monitors and communicates patient account balance to current and returning families.
• Provides a final balance statement and payment options to families with balances after the completion of medical services.
• Provides financial counseling to families who have outstanding balances who are receiving on-going treatment.
• Serves as a resource to problem solve self-pay financial issues.
• Develop, manage and document single case agreements with non-par Global Insurances and Payers.
• Identifies non-par payers and obtains appropriate authorization for treatment.
• Creates, communicates and documents executed single case agreement for non-par payers in Salesforce.
• Acts as a liaison between the Specialized Billing Office and payer to ensure appropriate information is provided to aid reimbursement.
• Communicates financial responsibility, expectations and process to families, payers and shareholders.
• Provides financial counseling to Global families, participates in family meetings with Clinical Coordinator as needed.
• Communicates financial expectations to external partners such as Insurances Companies, Foundations, Ministries of Health and Employers.
• Upon request, presents payer and patient financial expectations including financial case analysis and process specific data to internal and external partners.
• Performs administrative duties for all patient related vendor purchases, ensuring appropriate authorization, timely vendor payment and ensuring all necessary documentation available to the billing department for proper billing.
• Serves as a liaison between Global Medicine, Vendors and Payors.
• Works with vendors to obtain quotes for ordered medication, equipment or services, ensures authorization for requested medication, equipment or services is on file, processes requisitions for purchase orders, communicates purchase order and ordering instructions to vendors, initiates follow up on orders and assists when necessary in delivery coordination.
• Responsible for the prompt and accurate processing of over $650,000 in vendor expenses.
• Provides Salesforce and Epic administrative support and training to new IM staff.
• Other tasks as needed in support of the Business Manager or Director of Global Medicine Operations.

• Bachelor's Degree Required

• At least three (3) years of experience Required
• At least one (1) year experience working with international clients Preferred
• Experience in program coordination, organizational development, or related field Preferred

• Excellent oral and written communication skills.
• Excellent computer proficiency in MS Office applications.
• Excellent verbal, written and typing skills.
• Strong analytical skills and attention to detail.
• Ability to work independently and also with a broad range of people to collaboratively complete projects.
• Strong organizational and time management skills.
• Willing to advance professional skills and learn enhanced skills as they relate to job responsibilities.
• Working knowledge of international medicine/global health and/or healthcare systems, academic and/or graduate medical education (Preferred proficiency)

SALARY RANGE:

Salary ranges are shown for full-time jobs. If you're working part-time, your pay will be adjusted accordingly.

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At CHOP, we are committed to fair and transparent pay practices. Factors such as skills and experience could result in an offer above the salary range noted in this job posting. Click here for more information regarding CHOP's Compensation and Benefits.