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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.

The Department of Surgery at BIDMC provides state-of-the-art care for patients with a broad spectrum of conditions. Our physicians diagnose and treat patients with the latest medical care and surgical procedures.

The primary responsibility of the Referral Specialist will be to obtain prior authorization and approval directly from insurance companies in advance of surgical procedures to ensure coverage.

This position will be working with Beth Israel Deaconess Medical Center in Boston, MA and once fully trained, may have the option to work a hybrid or remote work schedule.

Job Description:

Establishes and maintains effective procedures for managed care referrals for the department with commitment to providing the highest quality of service to patients in the ambulatory practice.  Monitors outcomes to ensure insurance requirements are met. Provides referral management training and oversight  to staff.  Works closely with the Managed Care Office and BIDPO to communicate managed care principles and policies to the department.

Essential Responsibilities:

• Works with leadership to establish and maintain effective policies and procedures for managed care referrals, revenue cycle, and co-payment collection for the department. Ensures that all required managed care referrals for patient visits have been obtained or that a waiver is signed.
• Serves as primary resource on all departmental managed care matters; develops, implements and monitors departmental referral management processes, resource tools, and report findings on a regular basis.
• Represents the practice on hospital based Referral and Registration Operations committees. Acts as liaison between the practice and the managed care office and committees. Works closely with the physicians organization and the managed care office to communicate managed care principles and policies to the practice.
• Educates and trains administrative assistants and practice assistants in the area of Referral Management and Pre-Registration. Participates in administrative staff meetings reporting statistical referral management and pre-registration measurements and indicators, and communicating referral management information.
• Acts as a managed care resource on the unit to social workers, pharmacists, physicians, nurses and resource specialists for issues regarding managed care and insurance coverage, including commercial payers, Medicare, and radiology pre-certifications.

Required Qualifications:

• High School diploma or GED required. Associate's degree preferred.
• 3-5 years related work experience required.
• Two years of experience in referral management or insurance managed care environment.
• Experience with computer systems required, including web based applications and some Microsoft Office applications which may include Outlook, Word, Excel, PowerPoint or Access.

Competencies:

• Decision Making: Ability to make decisions that are guided by general instructions and practices requiring some interpretation. May make recommendations for solving problems of moderate complexity and importance.
• Problem Solving: Ability to address problems that are varied, requiring analysis or interpretation of the situation using direct observation, knowledge and skills based on general precedents.
• Independence of Action: Ability to follow precedents and procedures. May set priorities and organize work within general guidelines. Seeks assistance when confronted with difficult and/or unpredictable situations. Work progress is monitored by supervisor/manager.
• Written Communications: Ability to communicate clearly and effectively in written English with internal and external customers.
• Oral Communications: Ability to comprehend and converse in English to communicate effectively with medical center staff, patients, families and external customers.
• Knowledge: Ability to demonstrate full working knowledge of standard concepts, practices, procedures and policies with the ability to use them in varied situations.
• Team Work: Ability to act as a team leader for small projects or work groups, creating a collaborative and respectful team environment and improving workflows. Results may impact the operations of one or more departments.
• Customer Service: Ability to provide a high level of customer service to patients, visitors, staff and external customers in a professional, service-oriented, respectful manner using skills in active listening and problem solving. Ability to remain calm in stressful situations.

Physical Nature of the Job:
Sedentary work: Exerting up to 10 pounds of force occasionally in carrying, lifting, pushing, pulling objects. Sitting most of the time, with walking and standing required only occasionally.

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

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Why join Beth Israel Lahey Health?

If you’re looking for a career where you can make a difference and explore your potential, Beth Israel Lahey Health is the place you belong. Our system includes a network of hospitals, physician practices, outpatient centers, and other healthcare facilities and we offer a broad range of careers in direct patient care, environmental services, registration, finance and many other fields. We are focused on providing compassionate and personalized healthcare with a strong reputation for clinical excellence and research and offer diverse opportunities for career growth and development. Conveniently, we have many locations in communities across Eastern Massachusetts and Southern New Hampshire.

At Beth Israel Lahey Health, we see you for all that you are – your experience and your dreams. Explore our open opportunities and find out why so many have already chosen to join our team.

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