Managed Care Coordinator | Hybrid/Remote

Beth Israel Lahey Health•Wakefield, MA

2d•$23 - $30•Hybrid

About The Position

The Managed Care Coordinator initiates and processes managed care insurance referral requests for patients of BILH Primary Care Practices, with a focus on patient-centered care, timeliness, quality, and accuracy. The role follows the organization's Revenue Cycle Referral Management policy and practice turnaround-time targets. It also involves educating patients about care coordination and redirecting care within the BILH network. The coordinator works with BILH primary care providers, patients, practice staff, specialists, hospitals, and managed care payers to process specialty-care referral authorizations, communicate authorization details, and resolve referral or billing issues. The role uses multiple electronic systems to manage a high volume of requests, maintains knowledge of payer and specialty rules, handles confidential patient information, and helps train new hires in referral management.

Requirements

High school diploma or GED.
1–3 years of related work experience.
Experience with computer systems, including web-based applications and some Microsoft Office applications, which may include Outlook, Word, Excel, PowerPoint, or Access.
Ability to work with sensitive and confidential patient information while maintaining patient confidentiality.

Nice To Haves

Medical Administrative Assistant certification preferred.

Responsibilities

Coordinate and process specialty-care managed care referral authorization requests in accordance with BILHPN and BILH Hospitals contractual rules and agreements.
Use electronic technologies to initiate, issue, and administratively sign off on referrals, and remain proficient in the systems used by BILH practices and hospitals.
Serve as a daily point of contact and organizational resource for patients, families, specialty practices, physicians, and support staff on BILH managed care issues.
Communicate to specialists and/or patients the authorized level of care, number of visits, and extent of diagnostic testing.
Work with managed care payers and internal and external customers, including Patient Accounts, to resolve referral-management and patient-billing problems.
Help provide referral-management training to new hires.
Maintain current knowledge of referral and authorization rules and policies for multiple payers, specialties, and ancillary or diagnostic testing.
Work with patients and primary care providers to refer complex referral needs or situations to insurance-company case management.
Retrieve referral requests from Clinical Computing, Patient Site, OMR notes, emails, nurse triage, and patient voicemails; process requests and promptly communicate information to patients and specialty offices.
Coordinate with Patient Accounts, HMFP, the Financial Assistance Office, and other customers to help resolve billing problems.
Collaborate with the team to address new patients' referral-management issues and questions.
Maintain patient confidentiality when handling sensitive information.
Educate patients about care coordination and redirect care within the BILH network.