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Beth Israel Lahey Health
Westwood
**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.** The Manager Care Coordinator initiates and process managed care insurance referral requests for patients of BIL
Job Source: Beth Israel Lahey HealthSteward Health Care System LLC
Boston, MA, United States
Location: Steward Medical Group - North Posted Date: 5/23/2024 Job Type: Full Time Department: 1101.68020 CMGE Ent Unall Position Summary: The Referral Coordinator ensures Referrals made by the providers are processed to ensure our patients receive timely follow-up, on their diagnosis. They verify patient’s insurance and request author
Job Source: Steward Health Care System LLCBeth Israel Lahey Health
Boston, MA, United States
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 BI
Job Source: Beth Israel Lahey HealthBeth Israel Lahey Health
Boston, MA, United States
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 p
Job Source: Beth Israel Lahey HealthBeth Israel Lahey Health
Boston, MA, United States
**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, youre making a difference in peoples lives.** Job Summary: Works collaboratively with primary care or specialty physicians, their patients and practic
Job Source: Beth Israel Lahey HealthEast Boston Neighborhood Health Center
East Boston
Thank you for your interest in a career at NeighborHealth, formerly East Boston Neighborhood Health Center! Everywhere you turn, you can feel the immeasurable level of enthusiasm here at NeighborHealth! We are one of the largest community health centers in the country, supporting the greater Boston area and focusing on the well-being of our patient
Job Source: East Boston Neighborhood Health CenterBeth Israel Lahey Health
Boston
**Job Type:** Per Diem **Time Type:** Part 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.** Uses systems and billing knowledge to assist in all aspects of professional and facility billing on the front
Job Source: Beth Israel Lahey HealthHighmark Health
Boston
**Company :** Allegheny Health Network **Job Description :** **GENERAL OVERVIEW:** This job builds and maintains hospital, professional, and ASC contracts in Epic. Identifies underpaid accounts and articulates the source of the processing error to the payor. **ESSENTIAL RESPONSIBILITIES** + Provides support to senior analysts in building hospital,
Job Source: Highmark HealthWestwood, MA, United States
**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, youre making a difference in peoples 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:**
**The Managed Care Coordinator's Responsibilities are:**
1. 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.
2. 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.
3. 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.
4. 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.
5. 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.
6. 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.
7. 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.
8. 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.
**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) and COVID-19 as a condition of employment. Learn more (https://www.bilh.org/newsroom/bilh-to-require-covid-19-influenza-vaccines-for-all-clinicians-staff-by-oct-31) about this requirement.**
**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**
Email Alert for Managed Care/Referral Coordinator jobs in Westwood, MA, United States
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