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The Referral Specialist position will support the Department of Neurology at large and will be responsible for the processing of managed care referrals as well as prior authorizations.
This will begin as an on-site role, at Beth Israel Deaconess Medical Center in Boston, MA, Monday through Friday, first shift. Following three months of employment and upon being fully trained, the incumbent may work two days remotely per week.
Job Description:
Establishes and maintains effective procedures for managed care referrals for the department with commitment to providing the highest quality of service to patients in the ambulatory practice. Monitors outcomes to ensure insurance requirements are met. Provides referral management training and oversight to staff. Works closely with the Managed Care Office and BIDPO to communicate managed care principles and policies to the department.
Essential Responsibilities:
Works with leadership to establish and maintain effective policies and procedures for managed care referrals, revenue cycle, and co-payment collection for the department. Ensures that all required managed care referrals for patient visits have been obtained or that a waiver is signed.
Serves as primary resource on all departmental managed care matters; develops, implements and monitors departmental referral management processes, resource tools, and report findings on a regular basis.
Represents the practice on hospital based Referral and Registration Operations committees. Acts as liaison between the practice and the managed care office and committees. Works closely with the physicians organization and the managed care office to communicate managed care principles and policies to the practice.
Educates and trains administrative assistants and practice assistants in the area of Referral Management and Pre-Registration. Participates in administrative staff meetings reporting statistical referral management and pre-registration measurements and indicators, and communicating referral management information.
Acts as a managed care resource on the unit to social workers, pharmacists, physicians, nurses and resource specialists for issues regarding managed care and insurance coverage, including commercial payers, Medicare, and radiology pre-certifications.
Required Qualifications:
High School diploma or GED required. Associate's degree preferred.
3-5 years related work experience required.
Two years of experience in referral management or insurance managed care environment.
Experience with computer systems required, including web based applications and some Microsoft Office applications which may include Outlook, Word, Excel, PowerPoint or Access.
Competencies:
Decision Making: Ability to make decisions that are guided by general instructions and practices requiring some interpretation. May make recommendations for solving problems of moderate complexity and importance.
Problem Solving: Ability to address problems that are varied, requiring analysis or interpretation of the situation using direct observation, knowledge and skills based on general precedents.
Independence of Action: Ability to follow precedents and procedures. May set priorities and organize work within general guidelines. Seeks assistance when confronted with difficult and/or unpredictable situations. Work progress is monitored by supervisor/manager.
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 act as a team leader for small projects or work groups, creating a collaborative and respectful team environment and improving workflows. Results may impact the operations of one or more departments.
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.
Pay Range:
$23.15 - $34.40
The pay range listed for this position is the base hourly wage range the organization reasonably and in good faith expects to pay for this position at this time. Actual compensation is determined based on several factors, that may include seniority, education, training, relevant experience, relevant certifications, geography of work location, job responsibilities, or other applicable factors permissible by law. Compensation may exceed the base hourly rate depending on shift differentials, call pay, premium pay, overtime pay, and other additional pay practices, as applicable to the position and in accordance with the law.
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) as a condition of employment.
More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger.
Equal Opportunity Employer/Veterans/Disabled