Managed Care Coordinator

Beth Israel Lahey Health•Wakefield, MA

2d•$23 - $30

About The Position

The Manager Care Coordinator initiates and processes managed care insurance referral requests for patients of BILH Primary Care Practices, while maintaining a strong focus on patient-centered care, timeliness, quality, and accuracy. Adheres to the organization's Revenue Cycle Referral Management policy and meets targets regarding expected standard turnaround time goals as set by the practice. Facilitates discussions with patients to educate them regarding care coordination and redirects care within the BILH network.

Requirements

High School diploma or GED required.
1-3 years related work experience required.
Experience with computer systems required, including web-based applications and some Microsoft Office applications which may include Outlook, Word, Excel, PowerPoint or Access.

Nice To Haves

License Medical Admin Assistant Cert preferred.

Responsibilities

Work collaboratively with BILH PCPs, patients and practice support staff to coordinate, and process all specialty care managed care referral authorization requests in compliance with BILHPN and BILH Hospitals contractual rules and agreements for multiple managed care insurance payers. Utilize electronic technologies to initiate, issue, and administratively sign off on a high volume of referrals.
Learn and remain proficient on multiple electronic technologies used by the BILH practices and BILH Hospitals to initiate referral requests in an efficient and timely manner. Technologies will include but are not limited to (POS) Point of Service Device, Health Wire Network, Aetna WebMD, NEHEN, HPHC Connect, and other computer and web-based technology, Navinet and NIA.
Serve as a daily point of contact and as an organizational resource for BILH patients, families, specialty practices, physicians and support staff on BILH managed care related issues. Communicate to the specialist and/or patient the level of care, number of visits being authorized (e.g. one consult only vs. a consult and treatment), and the extent of the diagnostic testing being authorized.
Communicate with managed care payers to resolve patient referral management issues; coordinate with Patient Accounts, and other internal and external customers to resolve patient billing problems. Help provide referral management training to new hires. Work with extremely sensitive and highly confidential patient information and adhere to policy of maintaining patient confidentiality.
Maintain current knowledge base of referral and authorization plan rules and policies for multiple managed care payers and multiple specialties and ancillary/diagnostic testing as they apply to issuing PCP approvals. Work closely with patients and PCP's to refer patients with complex referral needs and complicated problems or situations to the case management at the insurance companies.
Retrieve patient referral requests through venues such as Clinical Computing, Patient Site, OMR notes, e-mails from Primary Care Physicians, nurse triage, and voice mails from patients; follow up appropriately with processing the referrals and promptly communicating the information back to the patient and/or specialty office.
Communicate with managed care payers to resolve patient referral management issues; coordinate with Patient Accounts, HMFP, the Financial Assistance Office, and other internal and external customers to serve as a resource person to resolve patient billing problems.
Collaborate with the entire team, in regard to servicing new patients' referral management related issues and questions.