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:    

Registration/Admission/Pre-Scheduling:

• 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, pati