When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.
Job Summary:
Under the direction of the Sr. Managed Care Coordinator and Practice Manager, initiate and process managed care insurance referral requests for patients of the practice, maintaining a focus on patient-centered care, timeliness, quality, and accuracy. Adhere to the organization's Revenue Cycle Referral Management policy and meet standard turnaround time goals set by the practice.
Job Description:
Essential Responsibilities:
* Collaborate with APG PCPs, patients, and support staff to coordinate and process all specialty care managed care referral authorization requests, complying with contractual rules for multiple payers.
* Utilize electronic technologies to initiate, issue, and sign off on high volumes of referrals, maintaining proficiency in systems such as POS, Health Wire Network, Aetna WebMD, NEHEN, HPHC Connect, Navinet, and NIA.
* Serve as a contact point for APG patients, families, specialists, physicians, and staff regarding managed care issues.
* Communicate authorization details, including care level, visit limits, and diagnostic testing, to specialists and patients.
* Resolve referral management issues with payers, coordinate with Patient Accounts, and assist in resolving billing problems.
* Provide referral management training to new hires.
* Handle sensitive patient information confidentially, adhering to privacy policies.
* Stay current with referral and authorization policies across multiple payers and specialties.
* Refer complex cases to insurance case management and work closely with patients and PCPs on complex referral needs.
Required Qualifications:
* High School diploma or GED.
* Certificate in Medical Admin Assistance preferred.
* 1-3 years related experience.
* Experience with web-based applications and Microsoft Office.
Competencies:
* Effective written and oral communication skills.
* Knowledge of healthcare policies, practices, and procedures.
* Teamwork and respectful interaction skills.
* High level of customer service, active listening, and problem-solving skills.
* Ability to remain calm under stress.
Physical Requirements:
Sedentary work involving sitting most of the time, with occasional walking, standing, and lifting up to 10 pounds.
Beth Israel Lahey Health requires all staff to be vaccinated against influenza as a condition of employment.
We are committed to diversity and equal opportunity in employment.
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