Beth Israel Deaconess Medical Center Referral Processing Rep in Needham, Massachusetts
Referral Processing Rep
Job LocationNeedham, Massachusetts
Req ID 18334BR
Department Description: nullJob Location: Needham, MAReq ID: 18334BRJob Summary: Under the direction of the APG Centralized Referral Department Supervisor, process managed care insurance referral requests for patients of APG Primary Care Practices, while maintaining a strong focus on patient-centered care, timeliness, quality, and accuracy of work. Adheres to the organization's Referral Management policy and meet targets regarding expected service level agreements as set by the department and practices. Covers phones and some Managed Care Coordinator duties as needed.
Works collaboratively with Managed Care Coordination department, APG PCPs, patients and practice support staff to coordinate and process all specialty care referral authorization requests in compliance with APG, BIDMC and BIDPO's contractual rules and agreements for multiple managed care insurance payers. Utilize electronic technologies to process high volume of referrals.
Constantly learn and remain proficient on multiple electronic technologies used by the APG practices and BIDMC to initiate referral requests in an efficient and timely manner. Technologies will include but are not limited to: (POS) Point of Service Device, Health Wire Network, Aetna WebMD, NEHEN, HPHC Connect, and other computer and web-based technology, Navinet, EMDEON, NIA, etc.
Serve as a daily point of contact and as an organizational resource for APG patients, families, specialty practices, physicians and support staff on referral processing related issues. Communicate to the specialist and/or patient the level of care, number of visits being authorized (e.g. one consult only vs. a consult and treatment), and the extent of the diagnostic testing being authorized.
Communicate with managed care payers to resolve patient referral management issues; coordinate with the Patient Accounts Dept, and other internal and external customers to resolve patient billing problems. Help provide referral processing training to new hires. Work with extremely sensitive and highly confidential patient information and adhere to policy of maintaining patient confidentiality.
Maintain current knowledge base of referral and authorization plan rules and policies for multiple managed care payers and multiple specialties and ancillary/diagnostic testing as they apply to issuing PCP approvals.
High School diploma or GED required.
1-3 years related work experience required.
Ability to work under pressure and as part of the team.
Ability to retain all previously learned knowledge.
Experience with computer systems required, including web based applications and some Microsoft Office applications which may include Outlook, Word, Excel, PowerPoint or Access.
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 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 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 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