GENERAL SUMMARY: Responsible for insuring timely appointments are made with specialists or PCPâ��s and for processing all insurance referrals as needed. The Appointment and Referral Coordinator will follow the AHO referral guidelines and work with the PCP or the staff and the patient to help direct care, when medically appropriate, to a specialist with the AHO network and to MetroWest services.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
Provide exceptional customer service to patients and office staff of the referring and receiving physicians.
Insure that a timely appointment is made with the receiving physician office and that communication flows smoothly between physicians and patients.
Process insurance authorizations electronically whenever possible. Process paper referrals for those insurance plans that do not have electronic capabilities.
Confirm eligibility of the member being referred.
Follow established AHO guidelines regarding AHO referrals; including pending referral for review by PCP or appropriate medical director and informing patient of the policies and protocols. Adapt to changes in guidelines if modified.
Communicate with primary care physicianâ��s office to discuss possible re-direction of out of AHO referrals utilizing the method approved by the physician.
Communicates effectively with manager, co-workers and patients.
Performs all duties in an independent manner using appropriate judgment in referring problems and questions to the supervisor.
Assist with the daily operations of the AHO as needed, including help with mailings.
Completes all other job duties as assigned by supervisor.
KNOWLEDGE, EXPERIENCE AND OTHER JOB REQUIREMENTS:
High School graduate or equivalent education required.
Must have a minimum of four years of experience working in a medical office setting.
One to three years health care experience either in the areas of patient registration or physician office.
Knowledge of hospital and medical terminology. Experience with hospital information systems. Excellent Customer Service skills. Knowledge and skill with Microsoft office.
Primary Location: Framingham, Massachusetts
Facility: MetroWest Framingham Union Hospital
Job Type: Full-time
Shift Type: Days
Employment practices will not be influenced or affected by an applicantâ��s or employeeâ��s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.
Internal Number: 2105025718
About MetroWest Framingham Union Hospital
Tenet Healthcare Corporation (NYSE: THC) is a diversified healthcare services company headquartered in Dallas with 112,000 employees. Through an expansive care network that includes United Surgical Partners International, we operate 65 hospitals and approximately 510 other healthcare facilities, including surgical hospitals, ambulatory surgery centers, urgent care and imaging centers and other care sites and clinics. We also operate Conifer Health Solutions, which provides revenue cycle management and value-based care services to hospitals, health systems, physician practices, employers and other clients. Across the Tenet enterprise, we are united by our mission to deliver quality, compassionate care in the communities we serve.