Referral Associate - Family Practice

Job Description

Welcome To

Welcome to Winchester Hospital, part of Beth Israel Lahey Health. Winchester Hospital was the first hospital in Massachusetts to earn Magnet recognition, the American Nurses Association’s highest honor for nursing excellence, three times. It has since received the recognition a fourth time. As the northwest suburban Boston area’s leading provider of comprehensive health care services, the 229-bed facility provides care in general, bariatric and vascular surgery, orthopedics, pediatrics, cardiology, pulmonary medicine, oncology, gastroenterology, rehabilitation, radiation oncology, pain management, obstetrics/gynecology and a Level IIB Special Care Nursery.

About the Job

JOB SUMMARY: Contributes to Winchester Physician Associate’s (WPA) mission by educating patients and their family members regarding their insurance and streamlining the referral process. This administrative/customer service staff position will have an impact on patient and physician satisfaction by providing empathetic and efficient communications to smooth the insurance claim process.

 QUALIFICATIONS:

Education:

Required: High school diploma or equivalent required.

Experience:

Required: At least two (2) years medical office or healthcare billing experience.

Other Skills/Knowledge:

Required:

• • Strong customer service skills including excellent interpersonal and telephone skills. Knowledge of medical terminology.

• • For safety and quality reasons, must be able to read, write and communicate effectively in English with patients, visitors and fellow members of the team.

Schedule Requirements: Schedule may vary based on practice and/or physicians’ needs.

 REPORTING RELATIONSHIPS:

• • Does not supervise others.
  • Reports to the Billing and Administrative Supervisor.

SECTION 2: PROMISE COMMITMENT

When patients enter our practices, they are entrusting us with a responsibility that is otherwise normally their own--the responsibility for their health, well-being, and often, their lives. To honor that trust, all Winchester Physician Associates (WPA) employees are expected to demonstrate the PROMISE behaviors of Winchester Hospital in every encounter with patients, coworkers, and the community. PROMISE is an acronym for the following:

Promoting Teamwork

Respect

Ownership

Maintaining a Positive Attitude

Initiative

Safety and Quality

Empathy

All WPA employees are expected to exemplify the PROMISE behaviors.

SECTION 3: COMPLIANCE COMMITMENT

WPA maintains a Compliance Program to ensure that employees comply with all laws, regulations and other licensure and accreditation standards that apply to our business.? The Code of Business Conduct is a vital part of the Compliance Program.? Employees must be familiar with the Compliance Program and Code of Business Conduct and must comply with their requirements and the requirements of any other laws and regulations, policies and procedures affecting the performance of their job. If applicable, employees are expected to comply with standards of conduct outlined by the oversight organization(s)?of their profession.

SECTION 4: JOB FUNCTIONS

Consistent with the PROMISE principles and inherent in a healthcare environment, employees must be flexible in meeting patients’ and the practice’s needs. While the list below describes the primary functions of this job, all employees of WPA need to recognize that an essential element of their job is the ability to respond to unanticipated and/or changing situations. This may result in assuming responsibilities or tasks which are not on this list.

As part of the practice team, this position:

• Educates patients about the practice’s referral policy. Communicates with patients regarding the need for referral authorizations and coordinates with other practitioner offices when necessary.
• Provides timely, courteous, informative and confidential insurance assistance for patients and their family members and assists patients in understanding their insurance.
• Stays current with insurance updates/changes that will facilitate accurate processing of any referral type, and knowledge of which referrals must be sent to provider. Maintains thorough knowledge and understanding of health care delivery systems with special expertise in the area of referral management for managed care providers and specialists.
• Serves as a backup for operator or front desk functions as needed.
• May provide assistance to Clinical Liaisons in preparing for patient appointments by reviewing, verifying and confirming visits to the practice. As part of this process may confirm or update insurance coverage information and/or confirm referral authorizations are in place at the time of scheduled practice visit and/or referrals for services provided outside the practice are on file.
• Identifies opportunities for providers to recommend in-IPA specialists to patients with pre-existing out of IPA providers.
• Comprehends current referral requirements and articulates clearly to patients and/or their family members so to provide a comfort-level regarding how the insurance plan works and to assist in streamlining insurance claims both for the practice and the patient.
• Attends regular meetings with IPA and Highland Management staff and others to remain updated on referral processes.
• Promotes communication among provider and patient and participates in problem solving efforts as required. Keeps practice leadership informed of problems and trends and makes recommendations to continually improve the referral and its related processes.
• Maintains a clean and safe work environment to enhance patient satisfaction and a culture of safety.
• Communicates effectively with the team utilizing established handoff procedures. Gives and accepts respectful feedback to enhance teamwork.
• Appropriately follows the chain of command and adheres to practice policies and procedures.

Shift

DAYS / FULL-TIME / 40 HOURS / TEWKSBURY

About Us

Beth Israel Lahey Health is an integrated system providing patients with better care wherever they are. Care informed by world-class research and education. We are doctors and nurses, technicians and social workers, innovators and educators, and so many others. All with a shared vision for what healthcare can and should be. We are committed to attracting, developing and retaining top talent. We strive to create a diverse and inclusive workplace that reflects the communities in which we work and serve. With a team approach to care, we encourage learning and growth at all levels and offer competitive salaries and benefits.

Equal Opportunity Employer/Minorities/Females/Disabled/Veterans.