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.
Position Administrative & Referral Coorinator
Department Primary Care Clinic
Schedule Full Time
ESSENTIAL DUTIES & RESPONSIBILITIES:
Referral Management
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.
Training/Orientation Support
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.
JOB REQUIREMENTS
EDUCATION
High School diploma required.
Additional professional certifications or completion of business school preferred.
Requires thorough knowledge of managed care with 3 years of experience of financial clearance.
3 years of referral scheduling experience preferred.
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.
Windows environment and Microsoft Office products preferred.
Knowledge of the Eclipsys SDK system, Caretracker and IDX or other comparable registration systems a plus.
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.
Compensation Range:
$21.39- $30.05
This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensures as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, BMCHS offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), discretionary annual bonuses and merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family well-being.
NOTE This range is based on Boston-area data, and is subject to modification based on geographic location.
Equal Opportunity Employer/Disabled/Veterans
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Boston Medical Center (BMC) is a 511-bed, equity-led academic medical center and a proud member of the Boston Medical Center Health System. BMC delivers a model of healthcare where innovative and equitable care empowers all patients to thrive. As a premier academic medical center in Boston, a national leader in clinical care, and the largest essential hospital in New England, BMC’s world-class clinicians provide comprehensive care in more than 70 specialties and subspecialties.
BMC understands that health equity is foundational to community wellbeing, and it requires transformative thinking, rewriting policies that have historically underserved communities, creating access to cutting-edge care for all, and co-creating programs with community partners that serve as national models for improving patient outcomes and experiences. We are invested in going above and beyond what is traditionally considered medicine to meet the needs of our communities and address disparities in clinical care and beyond.
By pioneering cutting-edge research and advancing scientific discovery, we are fostering a culture of innovation where novel treatments and therapies are not only effective but also accessible.
Boston Medical Center Health System is an integrated academic healthcare system that models a new kind of excellence in healthcare where clinical and operational innovation meets health equity and access. With more than 15,000 dedicated employees, BMC Health System is committed to advancing scientific discovery and access to care, partnering with our communities, and developing scalable approaches to restore and maintain health.
Visit jobs.bmc.org for career opportunities.
