Administrative & Referral Coordinator

POSITION SUMMARY:

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: