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Managed Care Coordinator


Department Description: Seeking part time employee for our Needham Cancer Center Departments and Specialties. Managed care role involves working collaborates with referring physicians, patients and support staff to request, obtain, record and attach specialty care referrals and authorization requests for multiple managed care insurance payers. This is an ideal position for someone who is well versed with insurance payors and guidelines and knows how to navigate websites to obtain referrals and authorizations. Candidate should be detailed oriented, compassionate in nature and outgoing. Although, working as part of the team, this candidate needs to be able to function independently and be able to multitask between the different clinics requiring referrals and authorizations. The candidate must also be comfortable with speaking with patients about out of pocket expense and insurance coverage.

Job Location: Needham, Massachusetts

Req ID: 41940BR


Job Summary: Works collaboratively with primary care or specialty physicians, their patients and practices to coordinate and process managed care referrals and / or authorizations for patient care services, complying with BIDCO's and BIDMC's contractual rules for multiple managed care insurance payers.

Essential Responsibilities:
  1. 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 managed care insurance payers for a high volume of patients.
  2. Utilizes electronic technologies to initiate, request, and procure a high volume of referral and authorizations for multiple managed care payers.
  3. Educates patients about the referral process, programs offered, and services provided at BIDMC and affiliated CareGroup institutions. Communicates to the provider and/or patient the level of care, number of visits being authorized.
  4. Communicates with managed care payers to resolve patient referral management issues. As appropriate, coordinates referrals with hospital's discharge planner and registration and pre-certification admitting department as required by the insurance company.
  5. Provides referral management training and oversight to department new hires. Contributes as a managed care resource for everyone on the unit including all patients, physicians, social workers, nurses, practice assistants, and support staff.
  6. Runs daily, weekly, and monthly statistical referral management and booking reports; enters data obtained from the reports into Excel spreadsheets.
  7. Coordinates daily with the Referral Specialist and the support staff team in the running of the referral management reports and enters information daily; collaborates on negative indicators to improve referral management outcomes.
Required Qualifications:
  1. High School diploma or GED required. Associate's degree preferred.
  2. 1-3 years related work experience required.
  3. Experience with computer systems required, including web based applications and some Microsoft Office applications which may include Outlook, Word, Excel, PowerPoint or Access.
Preferred Qualifications:
  1. Two years of experience in referral management or insurance managed care environment.
  2. Basic and complex medical coding and medical terminology.
  3. Primary care experience.
Competencies:
  1. Decision Making: Ability to make decisions that are based on specific instructions, standard practices and established procedures which generally require little or no supervision.
  2. Problem Solving: Ability to address problems that are routine, somewhat repetitive and generally solved by following clear directions and procedures and by identifying opportunities for process improvements.
  3. Independence of Action: Ability to follow general instructions and procedures as provided. Work is monitored by supervisor/manager.
  4. Written Communications: Ability to communicate clearly and effectively in written English with internal and external customers.
  5. Oral Communications: Ability to comprehend and converse in English to communicate effectively with medical center staff, patients, families and external customers.
  6. Knowledge: Ability to demonstrate full working knowledge of standard concepts, practices, procedures and policies with the ability to use them in varied situations.
  7. Team Work: Ability to work collaboratively in small teams to improve the operations of immediate work group by offering ideas, identifying issues, and respecting team members.
  8. 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
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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