Chart Reviewer

Brockton Neighborhood Health Center
Brockton, MA 02301
Tue Mar 15 2022 20:06:04 GMT+0000 (Coordinated Universal Time) save share
BROCKTON NEIGHBORHOOD HEALTH CENTER
POSITION DESCRIPTION
In order to prevent a direct threat to the safety and health of our patients and staff, effective August 1, 2021, new hires are required to have had at least the first dose of a COVID vaccine prior to their start, with the exception of those who have documented medical or religious exemptions. New hires who are not yet vaccinated can arrange to have the vaccine on site.


Title: Chart Reviewer

Department Head: Director of Practice Management

Job Summary:

To review and update the patient charts in the practice management system, under the direction and supervision of the Director of Practice Management.

Essential Functions:
  • Runs next day appointment in NextGen “Appointment list”
  • Review and update patient information within the following tabs:
  • Demographic, patient status, client defined, provider status, privacy status, Relations/Role, UDS and Chart Detail.
  • Review and update insurance information:
  • Verify patient eligibility through various insurance portals (MMIS, Harvard Pilgrim, Boston Medical Healthnet, Allways, Tuft Health Plan, and Blue Cross Blue Shield), including New England Healthcare Exchange Network (NehenTrizetto)
  • Contact insurance carrier by phone if there is no website available to verify eligibility
  • Set up insurance for appropriate office visit. For example, MBHP or Beacon for Mental Health, MH PCCP for under 65 y/o with Masshealth and D Doral MH or D HSN for dental.
  • Make sure that insurance information matches that of NextGen. For example: patient address, member ID, effective date, co-pays (OV & Specialty), deductible if applicable.
  • Set up medical insurance as primary, secondary and third if applicable.
  • Check mark and promote active and eligible insurance payers.
  • Uncheck and hide all inactive insurance.
  • Contact established patient if insurance is not eligible:
  • Book appointment with Intake department to resolve problem
  • Work closely with Intake if patient needs to enroll

Chart alerts are entered if patient is unavailable. Floor secretaries should be assisting and fixing problem charts upon patient registration the next day.
Once chart review is completed, chart is flag in appointment book “tracking status” with one the following categories: Fast track co-pay; Fast track, Balance, new patient, assigned to other PCP, needs to enroll, not eligible, see alert notes, verify address and telephone and verify UDS.
Additional Responsibilities:

Interpret as needed.
Must have knowledge of various insurance rules and regulations and how they relate in the referral processes.


Minimum Skills and Knowledge Requirements:

High school graduate or equivalent. Proficiency with computer, word processor, and spreadsheet programs. Some medical terminology helpful. Strong interpersonal skills needed. Good telephone manner and ability to screen information that may be confidential. Good organizational skills and the ability to prioritize daily workload. Bilingual preferred. Fluency in multiple languages strongly preferred.

Working Conditions:

Physical Demands: The individual must be capable of sitting at a desk for long periods; also, requires walking or driving between health center sites to retrieve necessary forms for processing of referrals. Occasional long hours may be required to accommodate work loads. Requires lifting of small pieces of office equipment and/or boxes not to exceed 20 pounds. Visual acuity sufficient for frequent reading. Hearing acuity sufficient for holding conversation with or without assistance of audio devices.

Personal Attributes: Ability to function during stress. Able to maintain patient confidentiality. Able to adapt to rapid change. Able to work as a liaison between patients, health center employees and referral sources.

At Brockton Neighborhood Health Center, we are dedicated to providing high quality health care that is delivered by Committed, Competent, Compassionate staff who respects the dignity, privacy, and equality of each patient and colleagues. Our team believes that Teamwork, Diversity, Respect, Customer service and Collaboration are essential for everyone to be successful in their role.

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