Managed Care Coordinator

Beth Israel Lahey Health; Wakefield (MA); On-site; USD 30,000 - 41,000; Full time

Job summary

Beth Israel Lahey Health is seeking a Manager Care Coordinator to process and manage care referral requests across BILH Primary Care Practices. You will ensure timely, accurate referrals, educate patients on care coordination, and resolve payer-related issues with internal teams.

This role emphasizes patient-centered service, confidentiality, and collaboration with PCPs, families, and staff to optimize referral workflows within the BILH network.

Qualifications

• High School diploma or GED required.
• License Medical Admin Assistant Cert 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.

Responsibilities

• Coordinate, and process all specialty care managed care referral authorization requests in compliance with contractual rules and agreements.
• Learn and remain proficient on multiple electronic technologies used by the BILH practices to initiate referral requests.
• Serve as daily contact for patients, families, specialty practices, physicians and staff on managed care issues.
• Resolve patient referral management issues with managed care payers and internal teams; assist with training new hires.
• Maintain knowledge of referral and authorization plan rules for multiple payers and specialties.
• Retrieve patient referral requests from various sources and communicate processed referrals back to patients or offices.
• Collaborate with the team to service new patients’ referral management issues and questions.

Skills

Customer service

Attention to detail

Education

High School diploma or GED

Tools

Microsoft Office

Job description

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

The Manager Care Coordinator initiates and process managed care insurance referral requests for patients of BILH Primary Care Practices, while maintaining a strong focus on patient-centered care, timeliness, quality, and accuracy. Adhere to the organization's Revenue Cycle Referral Management policy and meet targets regarding expected standard turnaround time goals as set by the practice. Facilitate discussions with patients to educate them regarding care coordination and redirect care within the BILH network.

Job Description

Responsibilities

• Work collaboratively with BILH PCPs, patients and practice support staff to coordinate, and process all specialty care managed care referral authorization requests in compliance with BILHPN and BILH Hospitals contractual rules and agreements for multiple managed care insurance payers. Utilize electronic technologies to initiate, issue, and administratively sign off on a high volume of referrals.
• Learn and remain proficient on multiple electronic technologies used by the BILH practices and BILH Hospitals 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 and NIA.
• Serve as a daily point of contact and as an organizational resource for BILH patients, families, specialty practices, physicians and support staff on BILH managed care 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 Patient Accounts, and other internal and external customers to resolve patient billing problems. Help provide referral management 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. Work closely with patients and PCP's to refer patients with complex referral needs and complicated problems or situations to the case management at the insurance companies.
• Retrieve patient referral requests through venues such as Clinical Computing, Patient Site, OMR notes, e-mails from Primary Care Physicians, nurse triage, and voice mails from patients; follow up appropriately with processing the referrals and promptly communicating the information back to the patient and/or specialty office.
• Communicate with managed care payers to resolve patient referral management issues; coordinate with Patient Accounts, HMFP, the Financial Assistance Office, and other internal and external customers to serve as a resource person to resolve patient billing problems.
• Collaborate with the entire team, in regard to servicing new patients' referral management related issues and questions.

Qualifications

• High School diploma or GED required.
• License Medical Admin Assistant Cert 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.

Pay Range

$22.50 - $30.00

The pay range listed for this position is the base hourly wage range the organization reasonably and in good faith expects to pay for this position at this time. Actual compensation is determined based on several factors, that may include seniority, education, training, relevant experience, relevant certifications, geography of work location, job responsibilities, or other applicable factors permissible by law. Compensation may exceed the base hourly rate depending on shift differentials, call pay, premium pay, overtime pay, and other additional pay practices, as applicable to the position and in accordance with the law.

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