Managed Care Coordinator

Beth Israel Deaconess Medical Center

Job Description

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Managed Care Coordinator

Department Description:Healthcare Associates (HCA) is a robust adult primary care practice at Beth Israel Deaconess Medical Center offering comprehensive health services to enhance the quality of life for our patients. Healthcare Associates (HCA) has received Level 3 (scale 1-3 with 3 as the highest) recognition as a Patient Centered Medical Home and averages 400 patient visits per day and manages a panel of 41,000 patients.

Job Location:Boston, MA

Req ID:35019BR

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:

  • 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.

  • Runs daily, weekly, and monthly statistical referral management and booking reports; enters data obtained from the reports into Excel spreadsheets.

  • 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:

  • High School diploma or GED required. Associate's degree preferred.

  • 1-3 years related work experience required.

  • 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:

  • Two years of experience in referral management or insurance managed care environment.

  • Basic and complex medical coding and medical terminology.

  • Primary care experience.

Competencies:

  • 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

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