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 patients referring physician and BMC other departments, including assuring that correspondence is disseminated properly; between providers and office support personnel.

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.
• 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.
• 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 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 (labs, radiology and billing).
• 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. Documents approval number, visits authorized, and type of service in the hospital registration system. Completes referral authorization paperwork and submits to the appropriate managed care organization in a timely manner. Delegates this task to patient access reps as appropriate.
• Prospectively identifies patients who require authorization for specialty care and obtains provider approval prior to the appointment date. Communicates alternatives to patients if service is denied.
• Generates audit reports from the Boston Medical Center registration and appointment scheduling system to monitor and troubleshoot inefficiencies in the referral authorization process. Recommends interventions and works with the Practice Manager to resolve.
• Coordinates updating of primary care provider assignments, member enrollment, disenrollment and transfers in the hospital registration system.
• Supports clinical and administrative staff regarding managed care guidelines and affiliated plans.
• Attends orientations conducted by managed care organizations, trains staff, and operationalizes new procedures at the…