Boston Medical Center (BMC) · 1 day ago
Administrative and Referral Coordinator - Orthopedic Surgery
Boston, MA
Full-time
Onsite
Mid Level
$19.95/hr - $27.88/hr
3+ years expBoston Medical Center (BMC) is a leading healthcare provider, and they are seeking an Administrative and Referral Coordinator for their Orthopedic Clinic. The role involves serving as a liaison for patients, facilitating access to care, managing referrals, and ensuring proper billing processes are followed.
Health CareHospitalMedicalNon Profit
Responsibilities
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
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
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
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
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
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
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
Perform other duties as needed
Qualification
Required
High School diploma required
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
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
Preferred
Additional professional certifications or completion of business school preferred
3 years of referral scheduling experience preferred
Experience handling patient flow is helpful
Knowledge of Windows environment and Microsoft Office products preferred
Benefits
Medical
Dental
Vision
Pharmacy
Discretionary annual bonuses
Merit increases
Flexible Spending Accounts
403(b) savings matches
Paid time off
Career advancement opportunities
Resources to support employee and family well-being
Company
Boston Medical Center (BMC)
Boston Medical Center (BMC) is a 511-bed, equity-led academic medical center and a proud member of the Boston Medical Center Health System.
5001-10000 employees
H1B Sponsorship
Boston Medical Center (BMC) has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (53)
2024 (51)
2023 (51)
2022 (38)
2021 (26)
2020 (32)
Funding
Current Stage
Late StageTotal Funding
$342.49MKey Investors
AmeriCorps Public AlliesNational Institute on Drug Abuse (NIDA)The Boston Foundation
2024-07-09Grant· $0.06M
2023-02-23Debt Financing· $232M
2019-04-23Grant· $89M
Leadership Team
David Beck
Senior Vice President & Chief Legal Counsel
Recent News
2025-11-11
2025-11-10
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