Referral Coordinator

The primary purpose of the Administrative & Referral Coordinator is to serve as a liaison for patients, referring practices and insurance companies in all communications regarding care rendered in the department.  Serves as a liaison with patients facilitating access to care, gathering information for pre-admission, registration, or admission of inpatients, ambulatory, emergency department patients that require surgical or interventional studies.  Schedules appointments, verify demographics and financial information.  Obtains pre-authorization from insurance carriers.  Responds to faxes and phone calls from insurers.  Assists the Department to meet targets established by Ambulatory Leadership Group.  Facilitates communication as follows:

• Between patient and surgeon or physician extenders (nurse practitioner and physician’s assistant)
• Between surgical physician extenders and operating room surgery scheduling personnel
• Between patient’s referring physician and surgical physician extenders, including assuring that correspondence is disseminated properly
• Between surgeon and academic office support personnel

Responsibilities/Duties:

Registration/Admission/Pre-Scheduling:

• Interview all patients, families or referring physicians to obtain all financial and demographic information required for reimbursement for services rendered.
• Enter patient registration data into appropriate systems according to established procedures to ensure proper reimbursement from third party payers (workers’ compensation, motor vehicle accidents, etc.) and patients.
• Correspond with insurance companies, health centers and other health facilities to obtain necessary prior approval numbers to ensure proper billing for payment of services prior to rendering their service.  Enter information into system as appropriate.
• Verify third-party insurance coverage (workers’ compensation, motor vehicle accidents, etc.) for prospective patients and verify day of service eligibility for appropriate insurance.
• Direct patients with financial concerns to staff who can assist in the completion of necessary forms and applications for financial assistance from private and/or public funding.  Adjunct free care applications.
• Collect deposits for flat fees and co-payments, as appropriate.
• Verify and update demographics, insurance and provider information on existing and new patients.
• Assign medical record numbers to new patients to ensure current information in the Master Patient Index (MPI) upon completion of a registration.
• Create and/or update occasion of service for surgical cases and other non-surgical visits or appointments during which referring physician and insurance information is recorded and electronically transmitted to other users within the Medical Center, i.e. labs, radiology and billing departments.
• Prior to scheduling verify that procedure meets medical necessity screening using appropriate software.
• Verify using appropriate electronic device the type of coverage and if prior approval for service is necessary for payment of services rendered.

Referral Management

• Coordinate managed care activities and devise program changes and developments to solve problems.
• Work cooperatively with administrative staff and providers to process referrals for patients.  Accurately document approval number, number of visits authorized, and type of service approved in the hospital registration system.  Complete the paperwork for referral authorizations and submit to appropriate managed care organization in a timely manner.  Delegate this task to patient access reps, as appropriate.
• Prospectively identify patients who require authorization for specialty care and obtains appropriate provider approval prior to the appointment date.  Effectively communicate alternatives to patient if service is denied.
• Generate audit reports from the Boston Medical Center registration and appointment scheduling system to monitor, troubleshoot inefficiencies in the referral authorization process.  Recommend interventions to and work with practice manager to resolve.
• Coordinate and assist with the updating of primary care provider assignments, member enrollment, disenrollment and transfers in the hospital registration system.
• Serve as a resource for clinical and administrative staff regarding managed care guidelines and affiliated managed care plans.
• Attend orientations conducted by managed care organizations, trains appropriate practice staff and operationalizes new procedures at the practice.
• Prepare and review automated registration and appointment scheduling reports on billing edits, registration quality, patient no shows, etc.  Initiate and implement corrective action as necessary.
• Monitor patient flow and patient satisfaction. Prospectively identify potential issues.  Trouble-shoot issues and work with Practice Manager to develop and implement systems to enhance efficiency.

Scheduling

• Answer telephone promptly and schedule surgical cases.
• Act as an expert and liaison to facilitate surgeon’s offices in scheduling cases.
• Utilize expertise and knowledge of O.R., Anesthesia and other areas to schedule all procedures based on type, allocation of operative team, time availability and specialty instruments.
• Determine limitation of cases by analyzing all the above information.  Handle all last-minute calls (emergency, cancellations, and elective) and appropriately assign priority.
• Ability to cope with high-pressure situations and demonstrate independent thinking and decision making as well as a high level of diplomacy.
• Deal discreetly with sensitive information, always maintaining confidentiality.
• Obtain and enter patient information and procedure data into hospital computer systems (SDK as appropriate).
• Review the following day OR schedule to finalize the schedule and to ensure data accuracy.
• At 24 hours before scheduled procedures, re-verify, using appropriate electronic device, the type of coverage and ensure that appropriate prior approval has been completed.
• Maintain records and files, as needed. Prepare reports relative to daily schedules, as needed.
• Respond to patient phone inquiries regarding office appointments, dates for surgery, and cost of surgery/hospital admission.

Appointment Scheduling

• Use computer to schedule appointments necessary for follow up appointments, H&Ps or other ancillary appointments, as appropriate.
• Use Outlook Calendar (or other appropriate scheduling software) and other computer programs to monitor the schedules of physicians avoiding conflicts and assuring that all commitments are properly noted on the physician’s schedules.
• Perform cross-booking appointment scheduling for social services, interpreters, preadmission screening, radiology and other clinical area appointments, as appropriate.
• Reschedule patients from cancelled or bumped surgical procedures.
• Facilitate urgent surgical appointments.

Other Support Duties

• Answer telephone calls in a courteous manner, maintains department files, and responds to inquiries from personnel, patients and physicians.
• Faxe patient records to other providers and insurance notification to insurers.
• Perform manual clinic scheduling and registration functions using accepted downtime procedures.
• Contact the Help Desk at the BMC computer department to report faulty systems or hardware.
• Notify area manager of problem(s) to ensure that it is addressed in a timely manner.
• Provide coverage to other areas under the direction of a manager and/or supervisor.
• Organize work area for efficiency, neatness and safety.
• Communicate with all members of staff on work related issues effectively and courteously.
• Assure all messages for physicians and designees are accurate and forwarded promptly to the physician and/or designee.
• Routinely handle large amounts of sensitive, confidential information and maintains confidentiality.
• Analize problems to determine appropriate course of action and offers constructive suggestions to improve efficiency in office operations

Meets hospital-wide standards in the following areas:

• Conform to hospital standards of performance and conduct, including those pertaining to patient rights, so that the best possible customer service and patient care can be provided.
• Utilize hospital’s Values as the basis for decision-making and to facilitate the division’s hospital mission.
• Follow established hospital infection control and safety procedures
• Maintain proper dress code.

OTHER DUTIES:

Perform other duties as needed.

Education

High School diploma required. Requires thorough knowledge of insurance products. 

Additional professional certifications or completion of business school preferred. 

Knowledge, Skills and Abilities:

• Working knowledge of managed care—overall understanding of HMO, PPO, and others; proficient knowledge of process of obtaining insurance approvals, referrals, billing, and co-payments.
• Experience handling patient flow is helpful
• Requires strong computer skills and knowledge of the PC applications. Windows environment and Microsoft Office products preferred.  Knowledge of the Eclipsys SDK system, PISCES and IDX or other comparable registration systems a plus. 
• Excellent English communication skills (verbal and written).
• Excellent professional demeanor. Must be able to work effectively with all levels of staff and management
• Excellent interpersonal skills. Must be able to show empathy and be courteous and diplomatic with patients.
• Must frequently work independently, take initiative and handle multiple tasks with conflicting priorities
• Team player with ability to work cross-organizationally to get issues resolved.
• Ability to maintain confidentiality.

Equal Opportunity Employer/Disabled/Veterans