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: Under the direction of the Sr. Managed Care Coordinator and Practice Manager initiate and process managed care insurance referral requests for patients of the practice, 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.
Job Description:Essential Responsibilities: Work collaboratively with APG PCPs, patients and practice support staff to coordinate, and process all specialty care managed care referral authorization requests in compliance with APG'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.Learn and remain proficient on multiple electronic technologies used by the APG practices and BIDMC 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 APG patients, families, specialty practices, physicians and support staff on APG 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
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