Administrative & Referral Coordinator, Whitman Primary Care

POSITION SUMMARY :

The primary purpose of the Administrative & Referral Coordinator is to serve as a liaison for patients, referring practices and insurance companies in all communications regarding care rendered in the department. Serves as a liaison with patients facilitating access to care, gathering information for pre-admission, registration, or admission of inpatients, ambulatory, emergency department patients that require surgical or interventional studies. Schedules appointments, verify demographics and financial information. Obtains pre-authorization from insurance carriers. Responds to faxes and phone calls from insurers. Assists the Department to meet targets established by Ambulatory Leadership Group. Facilitates communication as follows:

• Between patient and physician or physician extenders (nurse practitioner and physician’s assistant)
• Between physician extenders and other scheduling personnel
• Between patient’s referring physician and specialists, including assuring that correspondence is disseminated properly

Position: Administrative & Referral Coordinator,

Department: Whitman Primary Care

Schedule: Full Time

ESSENTIAL RESPONSIBILITIES / DUTIES:

• Interview all patients, families or referring physicians to obtain all financial and demographic information required for reimbursement for services rendered.
• Enter patient registration data into appropriate systems according to established procedures to ensure proper reimbursement from third party payers (workers’ compensation, motor vehicle accidents, etc.) and patients.
• Correspond with insurance companies, health centers and other health facilities to obtain necessary prior approval numbers to ensure proper billing for payment of services prior to rendering their service. Enter information into system as appropriate.
• Verify third-party insurance coverage (workers’ compensation, motor vehicle accidents, etc.) for prospective patients and verify day of service eligibility for appropriate insurance.
• Direct patients with financial concerns to staff who can assist in the completion of necessary forms and applications for financial assistance from private and/or public funding. Adjunct free care applications.
• Collect deposits for flat fees and co-payments, as appropriate.
• Verify and update demographics, insurance and provider information on existing and new patients.
• Assign medical record numbers to new patients to ensure current information in the Master Patient Index (MPI) upon completion of a registration.
• Create and/or update occasion of service for surgical cases and other non-surgical visits or appointments during which referring physician and insurance information is recorded and electronically transmitted to other users within the Health System, i.e. labs, radiology and billing departments.
• Prior to scheduling verify that procedure meets medical necessity screening using appropriate software.
• Verify using appropriate electronic device the type of coverage and if prior approval for service is necessary for payment of services rendered.

Referral Management

• Coordinate managed care activities and devise program changes and developments to solve problems.
• Work cooperatively with administrative staff and providers to process referrals for patients. Accurately document approval number, number of visits authorized, and type of service approved in the hospital registration system. Complete the paperwork for referral authorizations and submit to appropriate managed care organization in a timely manner. Delegate 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 communicate alternatives to patient if service is denied.
• Generate audit reports from the Boston Medical Center registration and appointment scheduling system to monitor, troubleshoot inefficiencies in the referral authorization process. Recommend 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.
• Attend orientations conducted by managed care organizations, trains appropriate practice staff and operationalizes new procedures at the practice.
• Prepare and review automated registration and appointment scheduling reports on billing edits, registration quality, patient no shows, etc. Initiate and implement corrective action as necessary.
• Monitor 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.

Scheduling

• Answer telephone promptly and schedule surgical cases.
• Serve as a liaison to facilitate surgeon’s offices in scheduling cases.
• Maintain confidentiality of patient information in accordance with policy
• Obtain and enter patient information and procedure data into hospital computer systems (SDK as appropriate).
• Maintain records and files, as needed. Prepare reports relative to daily schedules, as needed.
• Respond to patient phone inquiries regarding office appointments, dates for procedures, and cost of procedures.

Appointment Scheduling

• Use computer to schedule appointments necessary for follow up appointments, H&Ps or other ancillary appointments, as appropriate.
• Use Outlook Calendar (or other appropriate scheduling software) and other computer programs to monitor the schedules of physicians avoiding conflicts and assuring that all commitments are properly noted on the physician’s schedules.
• Perform cross-booking appointment scheduling for social services, interpreters, preadmission screening, radiology and other clinical area appointments, as appropriate.
• Reschedule patients from cancelled or bumped surgical procedures.
• Facilitate urgent surgical appointments.

Other Support Duties

• Answer telephone calls in a courteous manner, maintains department files, and responds to inquiries from personnel, patients and physicians.
• Faxe patient records to other providers and insurance notification to insurers.
• Perform manual clinic scheduling and registration functions using accepted downtime procedures.
• Contact the Help Desk at the BMC computer department to report faulty systems or hardware.
• Notify area manager of problem(s) to ensure that it is addressed in a timely manner.
• Provide coverage to other areas under the direction of a manager and/or supervisor.
• Organize work area for efficiency, neatness and safety.
• Assure all messages for physicians and designees are accurate and forwarded promptly to the physician and/or designee.
• Routinely handle large amounts of sensitive, confidential information and maintains confidentiality.

Meets system-wide standards in the following areas:

• Conform to health system standards of performance and conduct, including those pertaining to patient rights, so that the best possible customer service and patient care can be provided.
• Utilize health system’s Values as the basis for decision-making and to facilitate the division’s hospital mission.
• Follow established hospital infection control and safety procedures

Perform other duties as needed

JOB REQUIREMENTS

REQUIRED EDUCATION AND EXPERIENCE:

• High School diploma required and at least 1 year of related experience. Requires thorough knowledge of insurance products.

PREFERRED EDUCATION AND EXPERIENCE :

• Bachelor's Degree

CERTIFICATIONS, LICENSES, REGISTRATIONS REQUIRED:

• N/A

CERTIFICATIONS, LICENSES, REGISTRATIONS PREFERRED:

• N/A

KNOWLEDGE, SKILLS & ABILITIES (KSAs):

• Knowledge of managed care processes including HMO, PPO, and other plans, and the procedures for ; obtaining insurance approvals, referrals, billing, and co-payments.
• Ability to manage patient flow
• Proficiency with computer systems used in registration, scheduling, and insurance verification including Eclipsys SDK system, PISCES and IDX or other comparable registration systems as well Windows environment and Microsoft Office products a plus.
• Ability to communicate clearly in English through written and verbal channels .
• Ability to independently prioritize and complete multiple registration, scheduling, and referral tasks simultaneous
• Ability to maintain confidentiality

Compensation Range:

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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