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.
- Delivers referral management training on curriculums provided by Director. Drafts training program curriculums.
- Works with Director to incorporate new practices into Referral Management Program.
- Leads process improvement initiatives in referral management, especially with denials.
- Serves as resource for Managed care coordinators, and Admin staff in designated complex or large areas.
- Works with Director, to analyze staffing and training needs, based on level of complexity, Payer rules, managed care volumes, and patient sensitivity.
- Serve as a Web editor for the Ambulatory Referral Program Portal Page.
- Leads and prepares agenda items and presentations in forums.
- Monitors referral capture compliance; remedies and communicates managed care denial patterns and identifies root causes.
- Develops Educational 'Tips' of the month to be used Referral Program wide.
- Provides coverage for Outpatient Pharmacologic Authorization Specialist and coverage for Director of Referral Program. Other projects as assigned by Director.
- Bachelor's degree required.
- 3-5 years related work experience required.
- 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.
- Experience with billing processes, prior authorizations, billing systems, ability to research complex issues.
- Ability to compassionately interact with patients to to resolve complex payer coverage issues.
- 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.
- 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.
- 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.
- Written Communications: Ability to summarize and communicate in English moderately complex information in varied written formats to internal and external customers.
- Oral Communications: Ability to comprehend and communicate complex verbal information in English to medical center staff, patients, families and external customers.
- Knowledge: Ability to demonstrate in-depth knowledge of concepts, practices and policies with the ability to use them in complex 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 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
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