Chart Reviewer

PAY TRANSPARENCY STATEMENT:

In accordance with The Massachusetts Pay Transparency Act, BNHC provides reasonable pay range for each posted position. Actual compensation will be based on multiple factors such as relevant experience, education and training to determine offered rates. This range represents the organization's good faith estimate of the possible compensation at the time of posting.

Job Summary:

Under the direction and supervision of the Director of Practice Management or Practice Management Educator, verifies, and updates patient charts, registration information, insurance coverage, and appointment readiness in Epic. This position supports accurate patient access workflows, continuity of care, compliance with BNHC documentation standards, and protection of patient confidentiality.

Essential Functions:

Utilize Epic appointment reports (DAR) and work queues to review upcoming appointments and identify charts requiring registration, demographic, insurance, or documentation updates prior to the patient visit (3 days Prior)
Review and update patient demographic information, patient status, guarantor information, preferred language, communication preferences, PCP assignment, Emergency contact, MSPQ, FPL, UDS elements, Mychart and other required registration fields in Epic.

Review insurance coverage and verify eligibility through Epic RTE, other payer portals such as MMIS, Harvard Pilgrim, Wellsense, Mass General Brigham, Tufts Health Plan, Blue Cross Blue Shield, Availity, New England Healthcare Network (known as Nehen Tri Zetto) and other approved verification systems.

Confirm that insurance information in Epic matches payer information, including patient address, member , effective dates, copayments, specialty copayments, deductibles, coverage order, and eligibility status. Contact the insurance carrier by phone when online eligibility tools are unavailable or additional verification is required.

Attach and maintain accurate primary, secondary, and tertiary insurance coverage in Epic for the appropriate office visit or service type.

Help ensure insurance coverage information is active, accurate, and appropriately documented before the patient visit whenever possible.

Contact patients when insurance eligibility, registration discrepancies, missing information, or appointment readiness concerns are identified.

Coordinate with Intake to resolve insurance, registration, and coverage concerns before the patient visits whenever possible.

Schedule or refer patients to Intake when assistance is needed to obtain, renew, or correct health insurance coverage.

Enter appropriate Epic registration notes, alerts, tracking status updates, and follow-up documentation when patient outreach or staff action is required.

Use approved Epic workflows to flag charts (FYI) for follow-up, including but not limited to copay needs, fast track, balance, new patient, assigned to other PCP, needs to enroll, not eligible, see alert notes, verify address and telephone, and verify UDS.Assist with Epic work queues related to pre-registration, patient registration errors, insurance verification, and PCP mismatch.

Maintain patient confidentiality at all times and perform all duties in accordance with HIPAA, BNHC policies, and Practice Management procedures.

Additional Responsibilities:

Work one evening schedule weekly, as assigned and in accordance with department operational needs.

Complete an expected daily volume of chart reviews (average of 150-200) as assigned by the department, while maintaining accuracy, quality, and compliance with BNHC standards.

Maintain Certified Application Counselor (CAC) certification, if required for assigned insurance application support duties.

Maintain working knowledge of Epic registration, insurance, appointment, and workqueue functions required for the role.

Maintain knowledge of insurance rules and regulations that impact patient registration, insurance verification, and appointment readiness.

Participate in meetings, training, competency activities, and workflow updates to remain current with Epic system changes, payer requirements, and Practice Management procedures.

Provide language assistance only when qualified, authorized, and requested, in accordance with BNHC policies and applicable language access requirements.

May perform other duties as assigned by supervisor or department head.

Minimum Skills and Knowledge Requirements:

High school diploma or equivalent required. Proficiency with computers, word processing, spreadsheet…