Administrative and Referral Coordinator - Orthopedic Surgery

Overview

POSITION SUMMARY:

The primary purpose of the job is to serve as a liaison for patients in all communications regarding care rendered in the department. Serves as a liaison with patients facilitating access to care, gathering information for registration, schedules appointments, verify demographics and financial information. Obtains pre-authorization from insurance carriers. Responds to faxes and phone calls from patients, BMC departments and outside Facilities.

Assists the Department to meet targets. Facilitates communication as follows: between patient and providers, nurse practitioners and medical assistants; between patient's referring physician and BMC other departments, including assuring that correspondence is disseminated properly; between providers and office support personnel.

Position: Administrative and Referral Coordinator

Department:
Orthopedic Clinic

Schedule:
Full Time

Registration/Admission/Pre-Scheduling:

• 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.

Referral Management

• 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.

Scheduling

• Answers telephone promptly and schedules surgical cases.
• Acts as an expert and liaison to facilitate surgeon's offices in scheduling cases.
• Utilizes expertise and knowledge of O.R., Anesthesia and other areas to schedule all procedures based on type, allocation of operative…