SE-Referral Coordinator

St. Elizabeth's Medical Center; Boston (MA); On-site; USD 26,000 - 37,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

Bonuses and merit increases

Flexible Spending Accounts

403(b) matches

Paid time off

Career advancement

Job summary

St. Elizabeth's Medical Center in Boston seeks a Referral Coordinator to act as the primary liaison between patients, referring practices, and insurers to facilitate access to care and ensure smooth communication about clinical services.

The role coordinates the pre-admission, registration, and scheduling for surgical or interventional studies, verifies coverage, secures authorizations, and supports financial clearance to promote efficient patient flow.

Responsibilities

• Coordinate pre-admission, registration, and scheduling for surgical or interventional procedures.
• Verify third-party insurance coverage and obtain authorizations; inform patients and staff about coverage.
• Schedule surgical cases and follow-up appointments, considering OR availability, anesthesia, and instrument needs.
• Verify medical necessity and perform day-of-service eligibility checks; assign medical record numbers.
• Serve as liaison on managed care guidelines and train staff on updated referral protocols.
• Generate and review billing/edit reports; identify process inefficiencies and drive improvements.
• Coordinate patient access, cross-book ancillary services, and direct patients to financial counseling.

Job description

The Referral Coordinator serves as the primary liaison between patients, referring practices, and insurance companies to facilitate access to care and ensure seamless communication regarding clinical services. Operating under general supervision, this role is responsible for the coordination of pre-admission, registration, and scheduling for inpatient, ambulatory, and emergency department patients requiring surgical or interventional studies. The position ensures financial clearance and operational efficiency to support the department's clinical and strategic goals.

Patient Registration and Financial Clearance

Conducts interviews with patients, families, and referring providers to collect accurate demographic and financial data. Verifies third-party insurance coverage, including workers' compensation and motor vehicle accident claims, to ensure proper reimbursement.

Referral and Authorization Management

Obtains necessary prior approvals and authorizations from managed care organizations before services are rendered. Documents authorization details in the hospital registration system and communicates coverage alternatives or denials to patients and clinical staff.

Surgical and Clinical Scheduling

Coordinates the scheduling of surgical cases and follow-up appointments by analyzing O.R. availability, anesthesia requirements, and specialty instrument needs. Manages last-minute changes, such as emergencies or cancellations, to maintain optimal patient flow.

Insurance and Regulatory Compliance

Verifies medical necessity for procedures using designated software and performs day-of-service eligibility checks. Assigns medical record numbers and updates the Master Patient Index (MPI) to maintain data integrity.

Administrative Resource and Liaison

Serves as a subject matter expert for clinical and administrative staff regarding managed care guidelines. Attends orientations by payers to operationalize new procedures and trains practice staff on updated referral protocols. Initiates work/repair orders uses computer software /terminal for access data entry. Log issues with the ITS rounder or to the help desk. Arranges for delivery of expired/broken equipment/materials to appropriate repair site. Tracks and returns borrowed/rented equipment.

Data Monitoring and Reporting

Generates and reviews automated reports on billing edits, registration quality, and patient no-shows. Identifies inefficiencies in the referral process and collaborates with the Practice Manager to implement corrective actions.

Patient Access Coordination

Facilitates urgent surgical appointments and cross-books ancillary services, such as social work, interpreters, and radiology. Directs patients to financial counseling for assistance with free care applications and collects required co-

Compensation Range

$19.95- $27.88

This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensures as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness.

In addition, BMCHS offers generous total compensation that includes, but is not limited to:

• benefits (medical, dental, vision, pharmacy)
• discretionary annual bonuses and merit increases
• Flexible Spending Accounts
• 403(b) savings matches
• paid time off
• career advancement opportunities
• resources to support employee and family well-being

NOTE

This range is based on Boston-area data, and is subject to modification based on geographic location.

Equal Opportunity Employer/Disabled/Veterans