Beth Israel Deaconess Medical Center Managed Care Coordinator in Boston, Massachusetts
Managed Care Coordinator
Job LocationBoston, Massachusetts
Req ID 15873BR
Department Description: The Transplant Institute provides care to patients requiring liver, kidney or pancreas transplant, live kidney and liver donors, patients requiring dialysis access and patients who need hepatobiliary surgery. The Managed Care Coordinator will work closely with the Transplant Practice Specialists, Transplant Medical Assistants and Financial Coordinator to ensure that there is a referral in place for all outpatient office visits for Transplant Surgeons, Hepatologists, Nephrologist and Infectious Diseases Doctors. This position will also obtain prior authorizations for ancillary testing required for transplant patients. The environment is fast paced, high volume requiring attention to detail and strong organizational and communication skills.Job Location: Boston, MAReq ID: 15873BRJob 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.
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.
Utilizes electronic technologies to initiate, request, and procure a high volume of referral and authorizations for multiple managed care payers.
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.
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.
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.
High School diploma or GED required. Associate's degree preferred.
1-3 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.
Primary care experience
Basic and complex medical coding and medical terminology
Decision Making: Ability to make decisions that are based on specific instructions, standard practices and established procedures which generally require little or no supervision.
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.
Independence of Action: Ability to follow general instructions and procedures as provided. Work 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 work collaboratively in small teams to improve the operations of immediate work group by offering ideas, identifying issues, and respecting team members.
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