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, focusing on patient-centered care, timeliness, quality, and accuracy. Adhere to the organization's Revenue Cycle Referral Management policy and meet target turnaround times set by the practice.
Job Description:
Essential Responsibilities:
1. Collaborate with APG PCPs, patients, and support staff to coordinate and process all specialty care managed care referral authorization requests, complying with contractual rules and agreements for multiple payers.
2. Utilize electronic technologies to initiate, issue, and sign off on a high volume of referrals, maintaining proficiency in systems such as POS, Health Wire Network, Aetna WebMD, NEHEN, HPHC Connect, Navinet, and NIA.
3. Serve as a daily contact and resource for APG patients, families, specialists, physicians, and staff regarding managed care issues.
4. Communicate with specialists and patients about the level of care, number of visits authorized, and extent of diagnostic testing.
5. Coordinate with managed care payers to resolve referral issues and work with Patient Accounts and other departments to resolve billing problems.
6. Assist in training new hires in referral management processes.
7. Handle sensitive patient information confidentially, adhering to privacy policies.
8. Maintain current knowledge of referral and authorization policies across multiple payers and specialties.
9. Work closely with patients and PCPs to refer complex cases to insurance case management as needed.
Required Qualifications:
* High School diploma or GED.
* Certificate in Medical Admin Assistance preferred.
* 1-3 years of relevant work experience.
* Experience with computer systems, including web-based applications and Microsoft Office.
Competencies:
* Written and Oral Communications: Clear and effective communication skills in English.
* Knowledge: Understanding of standard concepts, practices, procedures, and policies.
* Teamwork: Respectful interaction with colleagues and external contacts.
* Customer Service: Providing high-quality service with active listening and problem-solving skills; remaining calm under stress.
Physical Requirements:
Sedentary work involving sitting most of the time, with occasional walking, standing, and exertion of up to 10 pounds of force.
Beth Israel Lahey Health requires all staff to be vaccinated against influenza and COVID-19 as a condition of employment.
#J-18808-Ljbffr