Administrative & Referral Coordinator - Orthopedic Surgery

BMC Software•Boston, MA

2d•$21 - $30

About The Position

The Administrative & Referral Coordinator serves as a liaison for patients regarding care provided by the Orthopedic Clinic. The role facilitates access to care, gathers registration information, schedules appointments, verifies demographic and financial information, obtains insurance pre-authorizations, and responds to calls and faxes from patients, BMC departments, and outside facilities. The coordinator supports communication among patients, providers, referring physicians, clinical staff, and office support personnel, and assists the department in meeting its targets. The position manages registration and pre-scheduling activities, including collecting and updating patient information, verifying insurance eligibility and coverage, obtaining prior approvals, recording authorizations, supporting financial-assistance processes, and creating or updating service records. It coordinates managed-care referrals, monitors authorization and registration processes, identifies and addresses workflow issues, and serves as a resource to clinical and administrative staff on managed-care guidelines. The coordinator schedules and reschedules appointments, coordinates appointments across clinical and support services, and facilitates urgent surgical appointments. The role also participates in system and process training, supports staff orientation, identifies training needs, and provides feedback and guidance to staff. The position is full-time in the Orthopedic Clinic. The listed compensation range is $21.39–$30.05; the range is an estimate and may vary based on relevant factors and geographic location.

Requirements

High school diploma required.
Thorough knowledge of managed care and three years of financial-clearance experience required.
Working understanding of HMO, PPO, and other managed-care plans, including insurance approvals, referrals, billing, and co-payments.
Strong computer skills and knowledge of PC applications required.
Excellent written and verbal English communication skills.
Professional demeanor and excellent interpersonal skills.
Ability to work effectively with all levels of staff and management.
Ability to demonstrate empathy and communicate courteously and diplomatically with patients.
Ability to work independently, take initiative, and manage multiple tasks with conflicting priorities.
Team-oriented approach and ability to work across organizational groups to resolve issues.
Ability to maintain confidentiality.

Nice To Haves

Associate or bachelor's degree preferred.
Three years of referral-scheduling experience preferred.
Experience handling patient flow is helpful.
Windows environment and Microsoft Office products preferred.
Knowledge of EPIC, Caretracker, IDX, or comparable registration systems is a plus.

Responsibilities

Interview patients, families, or referring physicians to obtain financial and demographic information needed for reimbursement.
Enter registration information into appropriate systems and ensure accurate patient records.
Contact insurance companies, health centers, and other facilities to obtain prior approvals and verify third-party coverage and day-of-service eligibility.
Direct patients with financial concerns to staff who can assist with financial-assistance forms and applications; assist with free-care applications.
Collect deposits and co-payments when applicable.
Verify and update demographic, insurance, and provider information for new and existing patients.
Assign medical record numbers and create or update service records for surgical and non-surgical visits.
Verify medical necessity screening, coverage type, and prior-approval requirements before scheduling or providing services.
Coordinate managed-care activities and work with administrative staff and providers to process patient referrals.
Document authorization numbers, authorized visit counts, and approved service types in the hospital registration system.
Complete and submit referral-authorization paperwork to managed-care organizations in a timely manner; delegate the task when appropriate.
Identify patients who need specialty-care authorization and obtain provider approval before appointments.
Communicate alternatives to patients when services are denied.
Generate and review registration and appointment-scheduling reports, monitor referral authorization processes, identify inefficiencies, and recommend or implement corrective actions with the Practice Manager.
Coordinate updates to primary-care-provider assignments, member enrollment, disenrollment, and transfers in the hospital registration system.
Serve as a resource to clinical and administrative staff on managed-care guidelines and plans; attend managed-care organization orientations and train appropriate practice staff on new procedures.
Monitor patient flow and satisfaction, anticipate potential issues, troubleshoot problems, and work with the Practice Manager to improve efficiency.
Schedule follow-up, H&P, and other ancillary appointments using scheduling systems and calendars while avoiding physician schedule conflicts.
Coordinate appointments across social services, interpreters, preadmission screening, radiology, and other clinical areas, as appropriate.
Reschedule patients affected by cancelled or bumped surgical procedures and facilitate urgent surgical appointments.
Attend required training sessions, meetings, and committees, and develop competencies to support staff training.
Define appropriate training methods, provide orientation and support to staff, assess department-wide training needs, and work with the business analyst to develop staff training status and needs reports.