Administrative & Referral Coordinator - Orthopedic Surgery

Interview all patients, families or referring physicians to obtain all financial and demographic information required for reimbursement for services rendered.

Enters 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.

Corresponds 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.

Verifies third-party insurance coverage (workers’ compensation, motor vehicle accidents, etc.) for prospective patients and verifies day of service eligibility for appropriate insurance.

Directs patients with financial concerns and directs them to staff who can assist them in the completion of necessary forms and applications for financial assistance from private and/or public funding.

Adjuncts free care applications.

Collects deposits for flat fees and co-payments, as appropriate.

Verifies and updates demographics, insurance and provider information on existing and new patients.

Assigns medical record numbers to new patients in order to ensure current information in the Master Patient Index (MPI) upon completion of a registration.

Creates and/or updates 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 verifies that procedure meets medical necessity screening using appropriate software.

Verifies using appropriate electronic device the type of coverage and if prior approval for service is necessary for payment of services rendered.

Coordinates managed care activities and devises program changes and developments to solve problems.

Works cooperatively with administrative staff and providers to process referrals for patients.

Accurately documents approval number, number of visits authorized, and type of service approved in the hospital registration system.

Completes the paperwork for referral authorizations and submits to appropriate managed care organization in a timely manner.

Delegates 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 communicates alternatives to patient if service is denied.

Generates audit reports from the Boston Medical Center registration and appointment scheduling system to monitor, troubleshoots inefficiencies in the referral authorization process.

Recommends 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.

Attends orientations conducted by managed care organizations, trains appropriate practice staff and operationalizes new procedures at the practice.

Prepares and reviews automated registration and appointment scheduling reports on billing edits, registration quality, patient no shows, etc.

Initiates and implements corrective action as necessary.

Monitors 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.

Uses computer to schedule appointments necessary for follow up appointments, H&Ps or other ancillary appointments, as appropriate.

Uses 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.

Performs cross-booking appointment scheduling for social services, interpreters, preadmission screening, radiology and other clinical area appointments, as appropriate.

Reschedules patients from cancelled or bumped surgical procedures.

Facilitates urgent surgical appointments.

Requires thorough knowledge of managed care with 3 years of experience of financial clearance.

3 years of referral scheduling experience preferred.

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 EPIC system, Caretracker 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.