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Program Manager, Referral Management


Department Description: Ambulatory Referral Management Program within Ambulatory Central Services. Hours are Monday-Friday from 8:30am - 5:00pm in Boston. Seeking recent experience in managed care referral management. Will serve as a resource across 300+ specialty clinics.

Job Location: Boston, MA

Req ID: 39265BR


Job Summary: The Referral Program Manager is responsible for supporting the Director of Referral Management in implementing a strategy with the overall goal of leading ambulatory practice leadership to meet the medical center's referral management revenue cycle policy and procedures. The manager will be a content expert and will work to expand the program across all Ambulatory clinics.

Essential Responsibilities:
  1. Delivers referral management training on curriculums provided by Director. Drafts training program curriculums.
  2. Works with Director to incorporate new practices into Referral Management Program.
  3. Leads process improvement initiatives in referral management, especially with denials.
  4. Serves as resource for Managed care coordinators, and Admin staff in designated complex or large areas.
  5. Works with Director, to analyze staffing and training needs, based on level of complexity, Payer rules, managed care volumes, and patient sensitivity.
  6. Serve as a Web editor for the Ambulatory Referral Program Portal Page.
  7. Leads and prepares agenda items and presentations in forums.
  8. Monitors referral capture compliance; remedies and communicates managed care denial patterns and identifies root causes.
  9. Develops Educational 'Tips' of the month to be used Referral Program wide.
  10. Provides coverage for Outpatient Pharmacologic Authorization Specialist and coverage for Director of Referral Program. Other projects as assigned by Director.
Required Qualifications:
  1. Bachelor's degree required.
  2. 3-5 years related work experience required.
  3. Advanced skills with Microsoft applications which may include Outlook, Word, Excel, PowerPoint or Access and other web-based applications. May produce complex documents, perform analysis and maintain databases.
Preferred Qualifications:
  1. Experience with billing processes, prior authorizations, billing systems, ability to research complex issues.
  2. Ability to compassionately interact with patients to to resolve complex payer coverage issues.
Competencies:
  1. Decision Making: Ability to make decisions that are guided by precedents, policies and objectives. Regularly makes decisions and recommendations on issues affecting a department or functional area.
  2. Problem Solving: Ability to address problems that are highly varied, complex and often non-recurring, requiring staff input, innovative, creative, and Lean diagnostic techniques to resolve issues.
  3. Independence of Action: Ability to set goals and determines how to accomplish defined results with some guidelines. Manager/Director provides broad guidance and overall direction.
  4. Written Communications: Ability to summarize and communicate in English moderately complex information in varied written formats to internal and external customers.
  5. Oral Communications: Ability to comprehend and communicate complex verbal information in English to medical center staff, patients, families and external customers.
  6. Knowledge: Ability to demonstrate in-depth knowledge of concepts, practices and policies with the ability to use them in complex varied situations.
  7. 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.
  8. Customer Service: Ability to provide a high level of customer service and staff training to meet customer service standards and expectations for the assigned unit(s). Resolves service issues in the assigned unit(s) in a timely and respectful manner.

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
EOE Statement

BIDMC is EOE M/F/VET/DISABILITY/GENDER IDENTITY/SEXUAL ORIENTATION

Vaccines

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. BILH requires that all staff be vaccinated against influenza (flu) and COVID-19 as a condition of employment. Learn more about this requirement

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