Referral Associate

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.

OTHER JOB REQUIREMENTS:

On-call Requirement:  N/A

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

Travel Requirements:  N/A

 REPORTING RELATIONSHIPS:

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

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:

• Provides timely, courteous, informative and confidential insurance assistance for patients and their family members and assists patients in understanding their insurance. 
• 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.

• 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.

• Attends regular meetings with IPA and Highland Management staff and others to remain updated on referral processes.
• 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.
• Identifies opportunities for providers to recommend in-IPA specialists to patients with pre-existing out of IPA providers.
• 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.
• Serves as a backup for operator or front desk functions as needed.

• 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.

• Appropriately follows the chain of command and adheres to practice policies and procedures.
• Communicates effectively with the team utilizing established handoff procedures.  Gives and accepts respectful feedback to enhance teamwork.
• Maintains a clean and safe work environment to enhance patient satisfaction and a culture of safety.

DEPARTMENT SPECIFIC JOB FUNCTIONS:

• Various special projects and responsibilities may be assigned to individuals to share the

      Workload and/or to recognize experience and/or performance.

Shift

Part Time

About Us

Beth Israel Lahey Health is dedicated to improving health and wellness and making a difference in the lives of our patients, their families and all members of the communities we serve.  Formed in March 2019, Beth Israel Lahey Health is a patient-centered, integrated care delivery system providing a continuum of services spanning academic, tertiary and community hospitals, dedicated orthopedic and psychiatric hospitals, primary and specialty care, community acute care, ambulatory care, behavioral services and home health.  Beth Israel Lahey Health Performance Network is a unified joint contracting and population health management organization, jointly governed by participating physicians and hospitals.

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