Lahey Health Managed Care Coordinator in Westwood, Massachusetts
Welcome to the Beth Israel Lahey Health Performance Network (BILHPN). BILHPN is a clinically integrated network of physicians, clinicians, and hospitals committed to providing high-quality, cost-effective care to the patients and communities they serve, while effectively managing medical expense. Leveraging best practices in population health management and data analytics, BILHPN improves care quality and patient health outcomes across Beth Israel Lahey Health through population health initiatives. BILHPN brings together the expertise of more than 4,500 providers across Eastern Massachusetts who share a common goal to achieve success in a value-based delivery system.
About the Job
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.
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.
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.
Full time, 40 hours per week, Monday - Friday
Beth Israel Lahey Health is an integrated system providing patients with better care wherever they are. Care informed by world-class research and education. We are doctors and nurses, technicians and social workers, innovators and educators, and so many others. All with a shared vision for what healthcare can and should be. We are committed to attracting, developing and retaining top talent. We strive to create a diverse and inclusive workplace that reflects the communities in which we work and serve. With a team approach to care, we encourage learning and growth at all levels and offer competitive salaries and benefits.
Equal Opportunity Employer/Minorities/Females/Disabled/Veterans.
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