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.

Administrative & Referral Coorinator

Primary Care Clinic

Full Time

• 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.

• 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.

• High School diploma required.

• Additional professional certifications or completion of business school preferred.

• Requires thorough knowledge of managed care with 3 years of experience of financial clearance.
• 3 years of referral scheduling experience preferred.

• Working knowledge of managed care: overall understanding of HMO, PPO, and others; proficient knowledge of process of obtaining insurance approvals, referrals, billing, and co-payments.
• Experience handling…