Managed Care Coordinator
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.
Required Qualifications:
- High School diploma or GED required. Associate's degree preferred.
- 1-3 years related work experience required.
- Two years of experience in referral management or insurance managed care environment.
- 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:
- Primary care experience
- Basic and complex medical coding and medical terminology