Department Description: We are seeking Managed Care Trainer for the Ambulatory Referral Management Program. This individual will provide Referral Management Training and Education to staff in assigned BIDMC Ambulatory areas. Seeking managed care insurance and referral experience.
Hours = 8:30AM-5:00PM Monday-Friday, Full-Time with Benefits.
Job Location: Boston, MA
Req ID: 35046BR
Job Summary: As an educator and content expert in the area of managed care referral management, this role serves as a dedicated trainer for the Ambulatory Referral Management Program.
- Deliver comprehensive Referral Management training classes, that cover managed care insurance and referral basics, hospital systems and websites, detailed HMO referral management, and referral capture Policies & Procedures.
- Develop My PATH trainings, and in-person presentations, on referral management, to align with industry Payer rules and with BIDMC Referral Management Policy and Procedures.
- Train on HMO/POS/EPO referral/service approval functions of web-based tracking tools. Maintain user training database, training schedules, class reminders, user evaluations, and user key access to various referral inquiry web-based tracking systems.
- Create and maintain educational managed care referral grids and resource tools for multiple Specialty Medical, Behavioral Health, and Primary Care areas in the outpatient setting. Research, outline, and articulate Managed Care Payer referral rules and documentation requirements.
- Serve as Web Editor for the Ambulatory Referral Program Portal Page. With the input of the Director, design and organize the Referral Management Portal page on the BIDMC intranet.
- Compile and analyze payer mix data for new areas to determine referral needs/opportunities.
- Participate in meetings/workgroups that address topics related to new initiatives, enhancements to existing systems, and to referral management. Participate in special projects as assigned by the Director.
- Work with Director and designated members of the Referral Program Training team to evaluate training effectiveness, and on-boarding processes offered within Ambulatory Referral Management Program. Offer recommendations to edit or redesign processes in order to improve efficiency and to align with the Policies and Procedures established by the organization.
- Analyze and help evaluate the training curriculums to ensure proper training objectives are met. Identify opportunities for enhancement and development.
- Assist in auditing work performed by trained staff and present findings and recommendations for areas of improvement to management.
- Associate's degree required. Bachelor's degree preferred.
- 3-5 years related work experience required.
- Knowledge of health care managed care revenue cycle.
- Ability to create and deliver lean training programs to align with Policies and Procedures.
- Experience training or teaching, and in being personable in mentoring others.
- 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.
- Knowledge of managed care insurance industry, products, and guidelines.
- 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