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PrimaCARE, P.C.

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Position: Manager of Referrals and Insurance Authorization
Location: Fall River, MA
Job Type: Full Time

Job Description:

The manager oversees activities and provides support for a multi-faceted clinical office. The manager provides excellent patient relations, interprets operating policies, and exercises independent judgment in the resolution of administrative and clinical problems. Their department may interact with patients, providers/offices, and third-party carriers with regard to patient-related issues, and serves as a resource in a team environment coordinating a smooth patient insurance verification/authorization/scheduling workflow process.

The department is responsible for referrals and authorizations where patients are sent to another practitioner (ex. specialist) for consultation or a health care service and a precertification process of reviewing certain medical or surgical to ensure medical necessity and appropriateness of care prior to services being rendered and also includes medical appropriateness (determination of whether the service being requested is a covered benefit under the patient’s current benefit plan).

Duties and Responsibilities:

  • Monitors the department's operation for identifying inefficiencies and finds ways to organize the daily function.
  • Demonstrates support for Central Division’s mission with a positive, constructive, and creative demeanor, while demonstrating compassion and a commitment to satisfying patient and family's needs at all times.
  • Responsible for hiring, training, and orientation of staff
  • Ensures effective daily staffing in accordance with overtime and employment policies and productivity.
  • Monitors performance, teamwork, and customer service; mentors and coaches staff as appropriate for performance improvement.
  • Provides effective communication through regular staff meetings, ongoing education and training. .
  • Supervises the process of obtaining written orders to ensure proper orders are received and documented for all procedures.
  • Develops and provides practical instruction, in-service, and continuing education for personnel.
  • Participates in the implementation, monitoring, and improvement of department quality indicators.
  • Interacts and communicates with providers, their office staff, and other health care professionals to facilitate department operations.
  • Oversees department payroll and attendance recording
  • Performs other duties as assigned

Skills and Qualifications:

  • Communicate with Supervisors, Peers, or Subordinates — by providing information to supervisors, co-workers, and subordinates by telephone, in written form, e-mail, or in person.
  • Computer literacy and multi-line phone experience-. If no experience, the prospective coordinator must quickly become proficient with these tasks.
  • Establishes and Maintains Interpersonal Relationships — by developing constructive and cooperative working relationships with others, and maintaining them over time.
  • Retrieves Information — by observing, receiving, and otherwise obtaining information from all relevant sources, like examining files or documents to obtain information
  • Interacts with Computers — by using computers and computer systems (including hardware and software) to set up functions, enter data, or process information.
  • Performs Administrative Activities — by doing day-to-day administrative tasks as listed under essential job functions
  • Works Directly with the Public — by greeting and communicating effectively and helpfully with patients, the general public and outside caregivers. This may include communicating with patients, family, and other outside providers following the Centers’ formal complaint process
  • Documenting/Recording Information — by entering, transcribing, recording, storing, or maintaining information in written, electronic or hardcopy form. Transcribe spoken or written information
  • Monitor Processes and Surroundings — by reviewing information from the environment, to detect or assess problems.
  • Processing Information — by compiling, coding, categorizing, calculating, tabulating, auditing, or verifying information or data.
  • Updating and Using Relevant Knowledge — by keeping up-to-date technically and applying new knowledge to your job.
  • Organizing, Planning, and Prioritizing Work — by developing specific goals and plans to prioritize, organize, and accomplish your work.
  • Assisting and Caring for Others — by providing personal assistance, medical attention, emotional support, or other personal care to others such as coworkers, customers, or patients.
  • Getting Information — by observing, receiving, and otherwise obtaining information from all relevant sources.
  • Communicating— by providing information to supervisors and co-workers by telephone, in writing, by e-mail, or in person.
  • Working with the Public — by dealing directly with patients and their family members.
  • Establishing and Maintaining Interpersonal Relationships — by developing constructive and cooperative working relationships with others, and maintaining them over time.
  • Organizing, Planning, and Prioritizing Work — by developing specific goals and plans to prioritize, organize, and accomplish your work.
  • Controlling Machines and Processes — by using either control mechanisms or direct physical activity to operate machines or processes (not including computers or vehicles).

Education/Experience:

  • 5 years plus experience within a medical office environment is required. Medical terminology required. Computer and proofreading skills required. Previous managerial experience preferred.
  • A High School diploma or graduation equivalency degree (GED) with an Associate’s Degree in business or five years’ experience in a leadership position is preferred. Strong computer skills required.

Benefits for our Permanent Placements Include:

  • Medical, Dental, Vision and Life Insurance
  • 401K/ROTH and Safe Harbor Plans
  • Paid Time Off

About PrimaCARE, P.C.:

Prima Care, P.C. was founded in 1996 and is a large, multi-specialty medical group serving southeastern New England. With over 150 providers, including primary care physicians and a broad range of specialists, we offer quality health care, a diversity of services and treatments, convenient and friendly service, and state-of-the-art testing facilities to support your diagnosis and treatments.
In addition to our main Fall River campus and walk-in Center, Prima Care has medical offices and Walk In centers in Somerset, Westport, and Dartmouth, as well as satellite offices in Tiverton, Rhode Island. We also provide care in patients’ homes, nursing homes and hospitals and two Outpatient Physical Therapy clinics located in Fall River and Somerset, MA.
We live and work by the golden rule and our company values that include integrity, respect, professionalism, ethical behavior and partnership.