Administrative & Referral Coordinator - Orthopedic Surgery

BMC Software•Boston, MA

1d•$21 - $30•Onsite

About The Position

The primary purpose of the job is to serve as a liaison for patients in all communications regarding care rendered in the department. Serves as a liaison with patients facilitating access to care, gathering information for registration, schedules appointments, verify demographics and financial information. Obtains pre-authorization from insurance carriers. Responds to faxes and phone calls from patients, BMC departments and outside Facilities. Assists the Department to meet targets. Facilitates communication as follows: Between patient and providers, nurse practitioners and medical assistants Between patient's referring physician and BMC other departments, including assuring that correspondence is disseminated properly Between providers and office support personnel.

Requirements

High School diploma required.
Thorough knowledge of managed care with 3 years of experience of financial clearance.
Working knowledge of managed care: overall understanding of HMO, PPO, and others; proficient knowledge of process of obtaining insurance approvals, referrals, billing, and co-payments.
Experience handling patient flow is helpful.
Requires strong computer skills and knowledge of the PC applications.
Excellent English communication skills (verbal and written).
Excellent professional demeanor.
Must be able to work effectively with all levels of staff and management.
Excellent interpersonal skills.
Must be able to show empathy and be courteous and diplomatic with patients.
Must frequently work independently, take initiative and handle multiple tasks with conflicting priorities.
Team player with ability to work cross-organizationally to get issues resolved.
Ability to maintain confidentiality.

Nice To Haves

Associates or Bachelor's degree preferred.
3 years of referral scheduling experience preferred.
Windows environment and Microsoft Office products preferred.
Knowledge of the EPIC system, Caretracker and IDX or other comparable registration systems a plus.

Responsibilities

Interview all patients, families or referring physicians to obtain all financial and demographic information required for reimbursement for services rendered.
Enter patient registration data into appropriate systems according to established procedures to ensure proper reimbursement from third party payers (workers’ compensation, motor vehicle accidents, etc.) and patients.
Correspond with insurance companies, health centers and other health facilities to obtain necessary prior approval numbers to ensure proper billing for payment of services prior to rendering their service.
Enter information into system as appropriate.
Verify third-party insurance coverage (workers’ compensation, motor vehicle accidents, etc.) for prospective patients and verifies day of service eligibility for appropriate insurance.
Direct patients with financial concerns and directs them to staff who can assist them in the completion of necessary forms and applications for financial assistance from private and/or public funding.
Adjunct free care applications.
Collect deposits for flat fees and co-payments, as appropriate.
Verify and update demographics, insurance and provider information on existing and new patients.
Assign medical record numbers to new patients in order to ensure current information in the Master Patient Index (MPI) upon completion of a registration.
Create and/or update occasion of service for surgical cases and other non-surgical visits or appointments during which referring physician and insurance information is recorded and electronically transmitted to other users within the Medical Center, i.e. labs, radiology and billing departments.
Prior to scheduling verify that procedure meets medical necessity screening using appropriate software.
Verify using appropriate electronic device the type of coverage and if prior approval for service is necessary for payment of services rendered.
Coordinate managed care activities and devise program changes and developments to solve problems.
Work cooperatively with administrative staff and providers to process referrals for patients.
Accurately document approval number, number of visits authorized, and type of service approved in the hospital registration system.
Complete the paperwork for referral authorizations and submits to appropriate managed care organization in a timely manner.
Delegate this task to patient access reps, as appropriate.
Prospectively identify patients who require authorization for specialty care and obtains appropriate provider approval prior to the appointment date.
Effectively communicate alternatives to patient if service is denied.
Generate audit reports from the Boston Medical Center registration and appointment scheduling system to monitor, troubleshoot inefficiencies in the referral authorization process.
Recommend interventions to and work with practice manager to resolve.
Coordinate and assist with the updating of primary care provider assignments, member enrollment, disenrollment and transfers in the hospital registration system.
Serve as a resource for clinical and administrative staff regarding managed care guidelines and affiliated managed care plans.
Attend orientations conducted by managed care organizations, train appropriate practice staff and operationalize new procedures at the practice.
Prepare and review automated registration and appointment scheduling reports on billing edits, registration quality, patient no shows, etc.
Initiate and implement corrective action as necessary.
Monitor patient flow and patient satisfaction.
Prospectively identify potential issues.
Troubleshoot issues and work with Practice Manager to develop and implement systems to enhance efficiency.
Use computer to schedule appointments necessary for follow up appointments, H&Ps or other ancillary appointments, as appropriate.
Use Outlook Calendar (or other appropriate scheduling software) and other computer programs to monitor the schedules of physicians avoiding conflicts and assuring that all commitments are properly noted on the physician’s schedules.
Perform cross-booking appointment scheduling for social services, interpreters, preadmission screening, radiology and other clinical area appointments, as appropriate.
Reschedule patients from cancelled or bumped surgical procedures.
Facilitate urgent surgical appointments.
Attend scheduled training sessions for systems upgrades or newly acquired clinical systems, registration updates, available resources for verifying insurance, and all trainings as required.
Attend and participate in meeting and/or organization committees, as required.
Develop necessary competencies in order to facilitate staff training.
Define appropriate training methods per case (virtual, simulated, mentoring, on the job training, professional, etc.).
Provide feedback/orientation and support to other staff related to the scope of this position.
Conduct department-wide training needs assessment and identify skills or knowledge gaps that need to be addressed.
In connection with our business Analyst, develop staff training status/need reports.