Job Description

The Referral management Coordinator is responsible for initiating, processing, and obtaining referrals and/or out-of-network authorization requests prior to a patient's scheduled appointment. The new team member will work with PCP offices and individual payors on verifying patient's demographics and/or checking on referrals/authorization statuses. Notifying patients and Tufts Medical Center clinics on any discrepancies that the patient might have that would affect the financial status of the appointment.

RESPONSIBILITIES:

• Reviewing and verifying scheduled outpatient visits for accuracy. This includes important demographic information and insurance information. Contact Tufts MC patient if any discrepancies are found.
• Submit referral request or out-of-network request based on Tufts Medical Center contracting rules.
• Manage daily ONTRAC work list and prioritize accordingly. Follow-up on pending cases, as needed.
• Verify insurance via eligibility tool or phone call to the payor.
• Submit referral request and follow up on any pending referrals to secure financial clearance prior to date of service. Document all steps taken in host system.
• Verify referrals received through E-Fax and linking them to patient accounts in hospital system while noting in Ontrac and DaVincian.
• Meet daily and weekly productivity standards.
• Provide excellent customer service when receiving in-bound calls from patients and doctors offices.

Qualifications

• Two to three years experience in insurance, managed care, private physician office practice or hospital registration setting.
• Level of knowledge generally obtained via completion of an Associates degree.
• High degree of delicacy is necessary due to frequent interaction with patients, physicians, and insurance companies.
• Thorough knowledge and understanding of health care delivery systems with special emphasis on the referral management process for managed care providers.
• Preferred understanding of Medicaid replacement products including ACO plans

Additional Information

AMERICANS WITH DISABILITIES STATEMENT: 

Must be able to perform all essential functions of this position with reasonable accommodation if disabled. 

The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed, as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. New England Medical Center reserves the right to modify position duties at any time, to reflect process improvements and business necessity. 

All your information will be kept confidential according to EEO guidelines. 

AMERICANS WITH DISABILITIES STATEMENT:

Must be able to perform all essential functions of this position with reasonable accommodation if disabled.

The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed, as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. Tufts Medical Center reserves the right to modify position duties at any time, to reflect process improvements and business necessity.

All your information will be kept confidential according to EEO guidelines.