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, while maintaining a strong focus on patient-centered care, timeliness, quality, and accuracy. Adhere to the organization's Revenue Cycle Referral Management policy and meet targets regarding expected standard turnaround time goals as set by the practice. Work collaboratively with APG PCPs, patients and practice support staff to coordinate, and process all specialty care managed care referral authorization requests in compliance with APG's, BIDMC's and BIDPO's contractual rules and agreements for multiple managed care insurance payers. Utilize electronic technologies to initiate, issue, and administratively sign off on a high volume of referrals. Learn and remain proficient on multiple electronic technologies used by the APG practices and BIDMC to initiate referral requests in an efficient and timely manner. Technologies will include but are not limited to (POS) Point of Service Device, Health Wire Network, Aetna WebMD, NEHEN, HPHC Connect, and other computer and web-based technology, Navinet and NIA. Serve as a daily point of contact and as an organizational resource for APG patients, families, specialty practices, physicians and support staff on APG managed care related issues. Communicate to the specialist and/or patient the level of care, number of visits being authorized (e.g. one consult only vs. a consult and treatment), and the extent of the diagnostic testing being authorized. Communicate with managed care payers to resolve patient referral management issues; coordinate with Patient Accounts, and other internal and external customers to resolve patient billing problems. Help provide referral management training to new hires. Work with extremely sensitive and highly confidential patient information and adhere to policy of maintaining patient confidentiality. Maintain current knowledge base of referral and authorization plan rules and policies for multiple managed care payers and multiple specialties and ancillary/diagnostic testing as they apply to issuing PCP approvals. Work closely with patients and PCP's to refer patients with complex referral needs and complicated problems or situations to the case management at the insurance companies. Required Qualifications: High School diploma or GED required. Certificate 1 Medical Admin Assistant Cert preferred. 1-3 years related work experience required. Experience with computer systems required, including web based applications and some Microsoft Office applications which may include Outlook, Word, Excel, PowerPoint or Access. Competencies: Written Communications: Ability to communicate clearly and effectively in written English with internal and external customers. Oral Communications: Ability to comprehend and converse in English to communicate effectively with medical center staff, patients, families and external customers. Knowledge: Ability to demonstrate full working knowledge of standard concepts, practices, procedures and policies with the ability to use them in varied situations. Team Work: Ability to interact respectfully with other employees, professional staff and/or external contacts to offer ideas, identify issues, obtain information or deliver services. Customer Service: Ability to provide a high level of customer service to patients, visitors, staff and external customers in a professional, service-oriented, respectful manner using skills in active listening and problem solving. Ability to remain calm in stressful situations. Physical Nature of the Job: Sedentary work: Exerting up to 10 pounds of force occasionally in carrying, lifting, pushing, pulling objects. Sitting most of the time, with walking and standing required only occasionally. As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) and COVID-19 as a condition of employment.
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