Managed Care Coordinator jobs in Massachusetts

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.

Under the direction of the BILHPN Centralized Referral Manager, identify opportunities and strategies to better coordinate patient care, pilot new initiatives, train Managed Care Coordinators, initiate 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 BILH. Facilitate discussions with patients to educate them regarding care coordination and redirect care within the BILH network.

Job Description:

Essential Duties & Responsibilities including but not limited to:

1.Serves as a coach, role model/mentor, providing support, training and sharing knowledge with other Managed Care Coordinators. Makes recommendations on how resources can be used differently and more effectively. Acts as a team leader for small projects. Assist with payroll approval and some management task when the manager is absent.
2.Serves as first point of contact for referrals, assigns tasks to Managed Care Coordinators (MCCs). With support of the Manager, Centralized Referral Mgmt prepares and adjusts MCC schedules, Identifies and resolves potential HIPAA compliance issues and assists with tracking of various important metrics. Collaborates with team; solicits thoughts and ideas from others and incorporates them to produce quality processes.
3. Work collaboratively with BILH PCPs, patients and practice support staff to coordinate, & process all specialty care managed care referral authorization requests in compliance with BILH's, BIDMC's and BIDPO's 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.
4.Learn and remain proficient on multiple electronic technologies used by the BILH practices to initiate referral requests in an efficient and timely manner. Technologies will include but are not limited to TRIZETTO, HPHC Connect, and other computer and web-based technology, Athena, Arcadia.
5. 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
6. Retrieve patient referral requests through venues such as Clinical Computing, Patient Site, OMR notes, emails 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.Ensure that Patient Health Information (PHI) will only be used for the purposes of patient treatment, payment and operations (TPO). APG patient personal health information is only shared with individuals who are actively managing the patient's care. NO other parties are entitled to receive, discuss a patient's personal health information without the patient's permission
8. 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.
9. 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.
10. Answer phones calls, providing full time phone coverage when needed
11. Assist with the writing of yearly Performance reviews for Managed Care Coordinators.
12. Work to redirect patients to stay within the Beth Israel Lahey Health Network.
13. Manage patient escalations.
14.Other projections, assignment and responsibilities may be added as needed.

Organizational Requirements:

• Maintain strict adherence to all BILH and BILHPN Policies.

• Maintain courteous and effective interactions with colleagues and providers and stake holders.

• Demonstrate an understanding of the job description, performance expectations, and competency assessment.

• Demonstrate a commitment toward meeting and exceeding the needs of our customers and consistently adheres to customer service standards.

• Participate in departmental and/or interdepartmental quality improvement activities.

• Participate in and successfully completes Mandatory Education.

• Perform all other duties as needed or directed to meet the needs of the department.

Minimum Qualifications:

Education:

• Highschool Diploma or GED required.

• Bachelor's degree preferred.

Licensure, Certification & Registration:

• Certificate 1 Medical Admin Assistant Cert preferred.

Experience:

• 3-5 years related work experience required.

Skills, Knowledge & Abilities:

• Experience with computer systems required, including web-based applications and some Microsoft Office applications which may include Outlook, Word, Excel, PowerPoint or Access. Customer Service, Written Communication, Oral Communication and Problem Solving.

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 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