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POSITION SUMMARY: The primary purpose of the job is to serve as a liaison for patients, referring practices and insurance companies in all communications regarding care rendered in the department. Serves as a liaison with patients facilitating access to care, gathering information for pre-admission, registration, or admission of inpatients, ambulatory, emergency department patients that require surgical or interventional studies. Schedules appointments, verify demographics and financial information. Obtains pre-authorization from insurance carriers. Responds to faxes and phone calls from insurers. Assists the Department to meet targets established by Ambulatory Leadership Group. Facilitates communication as follows:
Between patient and surgeon or physician extenders (nurse practitioner and physician's assistant) Between surgical physician extenders and operating room surgery scheduling personnel Between patient's referring physician and surgical physician extenders, including assuring that correspondence is disseminated properly Between surgeon and academic office support personnel
Position: Administrative & Referral Coordinator Department: OBGYN Schedule: Part Time ESSENTIAL RESPONSIBILITIES / DUTIES: 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 team, time availability and specialty instruments. Determines limitation of cases by analyzing all of the above information. Handles all last minute calls (emergency, cancellations, and elective) and is able to appropriately assign priority. Ability to cope with high-pressure situations and demonstrate independent thinking and decision making as well as a high level of diplomacy. Deals discreetly with sensitive information, maintaining confidentiality at all times. Obtains and enters patient information and procedure data into hospital computer systems (SDK as appropriate). Reviews the following day OR schedule to finalize the schedule and to ensure data accuracy. At 24 hours before scheduled procedures, re-verifies, using appropriate electronic device, the type of coverage and ensure that appropriate prior approval has been completed. Maintains records and files, as needed. Prepares reports relative to daily schedules, as needed. Responds to patient phone inquiries regarding office appointments, dates for surgery, and cost of surgery/hospital admission.
Appointment Scheduling
Uses computer to schedule appointments necessary for follow up appointments, H&Ps or other ancillary appointments, as appropriate. Uses Outlook Calendar (or other appropriate scheduling software) and other computer programs to monitor the schedules of physicians avoiding conflicts and assuring that all commitments are properly noted on the physician's schedules. Performs cross-booking appointment scheduling for social services, interpreters, preadmission screening, radiology and other clinical area appointments, as appropriate. Reschedules patients from cancelled or bumped surgical procedures. Facilitates urgent surgical appointments.
BMC /Professional Physician Billing Functions
Collects and organizes encounter forms after each clinic session. Reads and reviews each encounter form for completeness of data and data accuracy to assure clean claims processing. Follows departmental process plan for review of encounter form data. Research in the hospital information system any missing data required for charge entry processing. Enters charge information from the encounter form into the Hospital's information system for all clinic visits and procedure codes. Acts as liaison with all providers regarding gathering/capturing charge information and sending it to appropriate billing agent. Will organize encounter forms and prepare batch billing form to deliver to physician professional billing agent. Will liaison with professional billing agent on any trouble shooting issue and information gathering to assure claims processing. Implements and monitors quality control systems to track accuracy of submitted information. Assures charges and/ or reports are submitted daily. Extracts from hospital information system a series of reports that reconcile all encounter forms have been completed, encounter forms collected, patient visit encounter/arrival complete, patient insurance referral authorization in system, patient demographic and insurance information complete and accurate, charges fully entered. Extracts and prints from information system bill edit, missing authorization, missing charges, and missing diagnosis reports. Extracts other financial reports as needed to reconcile and verify charge entry process is complete and current. Liaison with ambulatory project manager leadership on any matter of failed charge entry process.
Training/Orientation Support
Attends scheduled training sessions for systems upgrades or newly acquired clinical systems, registration updates, available resources for verifying insurance, and all trainings as required. Attends and participates in meeting and/or committees, as required. Develops competencies as related to position. Provides feedback/orientation and support to other staff related to the scope of this position.
Other Support Duties
Answers telephone calls in a courteous manner, maintains department files, and responds to inquiries from personnel, patients and physicians. Faxes patient records to other providers and insurance notification to insurers. Maintains an adequate inventory of office supplies and order as needed. Performs manual clinic scheduling and registration functions using accepted downtime procedures. Contacts the Help Desk at the BMC computer department to report faulty systems or hardware. Notifies area manager of problem(s) to ensure that it is addressed in a timely manner. Provides coverage to other areas under the direction of a manager and/or supervisor. Organizes work area for efficiency, neatness and safety. Communicates with all members of staff on work related issues effectively and courteously. Assures that all messages for physicians and designees are accurate and forwarded promptly to the physician and/or designee. May assist in the preparation and submittal of payroll report as necessary. Routinely handles large amounts of sensitive, confidential information and maintains confidentiality. Analyses problems in order to determine appropriate course of action and offers constructive suggestions to improve efficiency in office operations
Meets hospital-wide standards in the following areas:
Conforms to hospital standards of performance and conduct, including those pertaining to patient rights, so that the best possible customer service and patient care can be provided. Utilizes hospital's Values as the basis for decision-making and to facilitate the division's hospital mission. Follows established hospital infection control and safety procedures Maintain proper dress code.
OTHER DUTIES:
(The above statements in this job description are intended to depict the general nature and level of work assigned to the employee(s) in this job. The above is not intended to represent an exhaustive list of accountable duties and responsibilities required). JOB REQUIREMENTS EDUCATION:
CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:
EXPERIENCE:
KNOWLEDGE AND SKILLS:
Requires thorough knowledge of managed care with 3 years of experience of financial clearance. Working knowledge of managed care: overall understanding of HMO, PPO, and others; proficient knowledge of process of obtaining insurance approvals, referrals, billing, and co-payments. Requires strong computer skills and knowledge of the PC applications. Windows environment and Microsoft Office products preferred. Knowledge of the Eclipsys SDK system, Caretracker and IDX or other comparable registration systems a plus. Excellent English communication skills (verbal and written). Excellent professional demeanor. Must be able to work effectively with all levels of staff and management Excellent interpersonal skills. Must be able to show empathy and be courteous and diplomatic with patients. Must frequently work independently, take initiative and handle multiple tasks with conflicting priorities Team player with ability to work cross-organizationally to get issues resolved. Ability to maintain confidentiality.
Equal Opportunity Employer/Disabled/Veterans According to the FTC, there has been a rise in employment offer scams. Our current job openings are listed on our website and applications are received only through our website. We do not ask or require downloads of any applications, or "apps" job offers are not extended over text messages or social media platforms. We do not ask individuals to purchase equipment for or prior to employment.
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Boston Medical Center
Jun 24, 2025