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Wellforce Referral Management Coordinator in Boston, Massachusetts

The Referral management Coordinator is responsible for initiating, processing, and obtaining referrals and/or out-of-network authorization requests prior to a patient’s scheduled appointment. The new team member will work with PCP offices and individual payors on verifying patient’s demographics and/or checking on referrals/authorization statuses. Notifying patients and Tufts Medical Center clinics on any discrepancies that the patient might have that would affect the financial status of the appointment.

Responsibilities:

  • Reviewing and verifying scheduled outpatient visits for accuracy. This includes important demographic information and insurance information. Contact Tufts MC patient if any discrepancies are found.

  • Submit referral request or out-of-network request based on Tufts Medical Center contracting rules.

  • Manage daily ONTRAC work list and prioritize accordingly. Follow-up on pending cases, as needed.

  • Verify insurance via eligibility tool or phone call to the payor.

  • Submit referral request and follow up on any pending referrals to secure financial clearance prior to date of service. Document all steps taken in host system.

  • Verify referrals received through E-Fax and linking them to patient’s accounts in hospital system while noting in Ontrac and DaVincian.

  • Meet daily and weekly productivity standards.

  • Provide excellent customer service when receiving in-bound calls from patients and doctors offices.

Qualifications:

  • Two to three years’ experience in insurance, managed care, private physician's office practice or hospital registration setting.

  • Level of knowledge generally obtained via completion of an Associates degree.

  • High degree of delicacy is necessary due to frequent interaction with patients, physicians, and insurance companies.

  • Thorough knowledge and understanding of health care delivery systems with special emphasis on the referral management process for managed care providers.

  • Preferred understanding of Medicaid replacement products including ACO plans

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