Administrative & Referral Coordinator

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. Administrative support for practice with faxes and forms processing.

Requirements

High School diploma required.
Requires 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.
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

Additional professional certifications or completion of business school preferred.
3 years of referral scheduling experience preferred.
Windows environment and Microsoft Office products preferred.
Knowledge of the Eclipsys SDK system, Caretracker and IDX or other comparable registration systems a plus.
Experience handling patient flow is helpful.

Responsibilities

Coordinates managed care activities and devises program changes and developments to solve problems.
Works cooperatively with administrative staff and providers to process referrals for patients.
Accurately documents approval number, number of visits authorized, and type of service approved in the hospital registration system.
Completes the paperwork for referral authorizations and submits to appropriate managed care organization in a timely manner.
Delegates 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 communicates alternatives to patient if service is denied.
Generates audit reports from the Boston Medical Center registration and appointment scheduling system to monitor, troubleshoots inefficiencies in the referral authorization process.
Recommends 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.
Attends orientations conducted by managed care organizations, trains appropriate practice staff and operationalizes new procedures at the practice.
Prepares and reviews automated registration and appointment scheduling reports on billing edits, registration quality, patient no shows, etc.
Initiates and implements corrective action as necessary.
Monitors patient flow and patient satisfaction.
Prospectively identify potential issues.
Trouble-shoot issues and work with Practice Manager to develop and implement systems to enhance efficiency.
Attends scheduled training sessions for systems upgrades or newly acquired clinical systems, registration updates, available resources for verifying insurance, and all trainings as required.
Attends and participates in meeting and/or organization committees, as required.
Develops necessary competencies in order to facilitate staff training.
Defines appropriate training methods per case (virtual, simulated, mentoring, on the job training, professional, etc.)
Provides 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, develops staff training status/need reports.