• Managed Care Coordinator

    Beth Israel Lahey Health (Westwood, MA)


    **Job Type:** Regular

    **Time Type:** Full time

    **Work Shift:** Day (United States of America)

    **FLSA Status:** Non-Exempt

     

    When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.

     

    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.

    Job Description:

    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.

     

    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. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) as a condition of employment.

     

    More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger.

     

    Equal Opportunity** **Employer/Veterans/Disabled