Managed Care Coordinator
The Managed Care Coordinator will support the ObGyn Department at Beth Israel Deaconess Medical Center in Boston, MA. The Managed Care Coordinator role is a hybrid work model, promoting a balance between on-site and remote work. Once fully trained, the standard expectation is for employee to be on-site two days a week, enjoying the flexibility of remote work for the remaining days. The anticipated hours of work are Monday to Friday 8:00Am to 4:30PM. We value adaptability and may require additional on-site presence if the need arises, such as providing coverage during leave of absence or other time away. This flexible approach allows our team to thrive in a dynamic work environment, ensuring seamless support for our colleagues and patients.
Job Description: Works collaboratively with primary care or specialty physicians, their patients and practices to coordinate and process managed care referrals and/or authorizations for patient care services, complying with BIDCO's and BIDMC's contractual rules for multiple managed care insurance payers.
Essential Responsibilities:
- Collaborates with referring physicians, patients and support staff to request, obtain, record, and attach primary and/or specialty care managed care referral and authorization requests for multiple managed care insurance payers for a high volume of patients.
- Utilizes electronic technologies to initiate, request, and procure a high volume of referral and authorizations for multiple managed care payers.
- Educates patients about the referral process, programs offered, and services provided at BIDMC and affiliated CareGroup institutions.
- Communicates to the provider and/or patient the level of care, number of visits being authorized.
- Communicates with managed care payers to resolve patient referral management issues.
- As appropriate, coordinates referrals with hospital's discharge planner and registration and pre-certification admitting department as required by the insurance company.
- Provides referral management training and oversight to department new hires.
- Contributes as a managed care resource for everyone on the unit including all patients, physicians, social workers, nurses, practice assistants, and support staff.
- Runs daily, weekly, and monthly statistical referral management and booking reports; enters data obtained from the reports into Excel spreadsheets.
- Coordinates daily with the Referral Specialist and the support staff team in the running of the referral management reports and enters information daily; collaborates on negative indicators to improve referral management outcomes.
Required Qualifications:
- High School diploma or GED required.
- Associate's degree 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.
Preferred Qualifications:
- Two years of experience in referral management or insurance managed care environment.
- Basic and complex medical coding and medical terminology.
- Primary care experience.