Referral Mgt Coordinator - Patient Access

It takes a lot of very smart, hard-working and talented people to provide the level of care that we give to our patients. Tufts Medical Center is an internationally respected academic medical center and we pride ourselves not only on the sophistication of the care we deliver, but the compassionate way in which we provide it. And that starts with our employees.

Responsible for initiating, processing, and obtaining referrals and/or out-of-network authorization requests prior to a patient’s scheduled appointment. The Referral Management Coordinator 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.

PRINCIPAL DUTIES AND ESSENTIAL FUNCTIONS:

• 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’s 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.

JOB KNOWLEDGE AND SKILLS:

• The ability to multitask and follow through with day to day responsibilities.
• Two to three years’ experience in insurance, managed care, private physician’s office practice or hospital registration setting.
• The ability to work efficiently as a team and/or independently.
• Strong customer service skills and excellent telephone etiquette with the capability to communicate effectively with all hospital employees.
• High degree of delicacy is necessary due to frequent interaction with patients, physicians, and insurance companies.
• Knowledgeable of Microsoft office, Davincian, Ontac, RCO, and payor websites preferred.
• 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
• Excellent organizational skills required with attention to detail.

EDUCATION

• Level of knowledge generally obtained via completion of an associate degree.

EXPERIENCE:

• One to two years of experience in insurance, managed care, private physician’s office practice or hospital registration setting.
• An equivalent combination of education and experience, which provides proficiency in the areas of responsibility listed above, may be substituted for the above education and experience requirements.

WORKING CONDITIONS/PHYSICAL DEMANDS:

• Works in a fast-paced, high-pressure office environment. There will be significant pressure to meet or exceed goals and expectations. There is little discomfort due to dust, dirt or other environmental factors.
• Constant contact with patients, internal and external physicians, payers and Tufts MC managerial staff.

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.

COVID-19 POLICY:

Please note that effective October 1, 2021, as a condition of employment at Tufts Medical Center, all employees and new hires must have received their complete dose of the COVID-19 vaccine, unless they have been granted an exemption.