Overview Managed Care Coordinator, ObGyn Boston, Massachusetts. Hybrid work model with on-site two days a week and remote work for the remaining days. Anticipated hours are Monday to Friday, 8:00 AM to 4:30 PM. This role supports the ObGyn Department at Beth Israel Deaconess Medical Center in Boston, MA, coordinating managed care referrals and authorizations in compliance with contractual rules for multiple payers.
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 payers for a high volume of patients.
Utilizes electronic technologies to initiate, request, and procure referrals and authorizations for multiple payers.
Educates patients about the referral process, programs offered, and services provided; communicates the level of care and number of visits being authorized to providers and patients.
Communicates with managed care payers to resolve referral management issues; coordinates referrals with the hospitals discharge planner and registration/pre-certification admitting department as required by the insurer.
Provides referral management training and oversight to department new hires; acts as a managed care resource for the unit.
Runs daily, weekly, and monthly referral management and booking reports; enters data into Excel spreadsheets.
Coordinates daily with the Referral Specialist and support staff on referral management reports; collaborates on negative indicators to improve outcomes.
Required Qualifications High School diploma or GED required; Associates degree preferred.
1-3 years related work experience required.
Experience with computer systems, including web-based applications and some Microsoft Office applications (Outlook, Word, Excel, PowerPoint or Access).
Preferred Qualifications Two years of experience in referral management or an insurance managed care environment.
Basic and complex medical coding and medical terminology.
Competencies Decision Making: Able to make decisions based on instructions, standard practices, and established procedures with minimal supervision.
Problem Solving: Addresses routine problems and identifies opportunities for process improvements.
Independence of Action: Follows general instructions; work is monitored by a supervisor/manager.
Written Communications: Clear written English with internal and external customers.
Oral Communications: Clear spoken English with medical center staff, patients, families and external customers.
Knowledge: Demonstrates working knowledge of standard concepts, practices, procedures and policies.
Team Work: Works collaboratively to improve operations within the work group.
Customer Service: Delivers high-quality customer service with active listening and problem solving; remains calm in stressful situations.
Physical Nature of the Job: Sedentary work involving occasional lifting up to 10 pounds; mostly sitting with walking/standing required occasionally.
As a health care organization, we have a responsibility to care for our patients, colleagues, and communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza as a condition of employment.
Equal Opportunity Employer/Veterans/Disabled.
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