IL Per Diem Referral Processing Specialist

Advocate Health and Hospitals Corporation•Oak Brook, IL

19h•Hybrid

About The Position

This is an as-needed, part-time position within the IL Home Health Divisional - Patient Access department. The role requires availability to work weekends and holidays on a rotation, with a mandatory training schedule of over 32 hours a week for the first 13 weeks (90 days), weekdays from 8:30 AM to 5 PM. Candidates must have experience in a clinical setting and/or with medical insurance verification, and proficiency with EPIC. The position requires the ability to work both in-office and remotely from home, with reliable home internet (100-300Mbps suggested) and the ability to connect via ethernet cable. The pay range for this position is $20.80 - $31.20.

Requirements

HS diploma
2 years of experience in a medical office setting
Experience with Medical Insurance verification
EPIC experience
Knowledge of medical terminology and health care industry
Knowledge of Medicare/Medicaid and other third party payers
Strong communication skills (both oral and written)
Able to work effectively with all colleagues, to ensure the seamless referral processing
Ability to work well in a team environment with a positive attitude
Appreciation of the need for and ability to maintain confidentiality
Rational/logical decision making
Ability to prioritize work and work unsupervised for periods of time
Strong interpersonal skills
Ability to take responsibility for processing referrals within timeframes and responding to queries about Medicare, Medicaid and Managed Care Services
Competent in the use of a range of software packages including Microsoft Office, Word and Excel (used daily)
Ability to follow through on tasks and communicate between and among team members
Ability to respond to callers professionally and courteously
Ability to express self clearly and assertively, and work in a busy office
Independent thinker
High energy, self-starter
Effective communicator
Detail oriented
Work flexible hours
Occasional travel to other Advocate and referral locations as necessary in all weather conditions on all types of roads including expressways
10 lbs or less regularly of office supplies/equipment to perform job
20-50 lbs occasionally (e.g. box of of paper)

Nice To Haves

Call center experience a plus

Responsibilities

Provide support to the day-to-day operations of the Customer Service Center.
Provide triaging of home health referrals from referral sources received telephonically, electronically or by fax with exceptional customer service.
Assemble referral information in the home health electronic medical record (EMR) including monitoring interface of data from other electronic systems.
Process referrals in a timely, complete, and accurate manner to achieve and maintain exceptional levels of performance that includes customer service.
Screen and troubleshoot phone calls from referral sources and route concerns to the appropriate department or leadership.
Order and maintain office supplies, forms, and equipment as needed.
Assist with report monitoring and follow-up on pending patients.
Maintain effective communication with referral sources, physicians, home care liaisons, and intake RNs to ensure adherence to company policies, guidelines, and processes.
Maintain knowledge of all insurance plans including Medicare, Medicaid, and Managed Care procedures and guidelines.
When entering referrals, correctly identify insurance coverage, investigate and verify sources of reimbursement, and make recommendations based on the information obtained.
Identify insurance coverage, benefits available, patient's out-of-pocket costs, co-insurance, co-payment, and deductible.
Determine if payer's coverage requirements are met for services.
Follow established department guidelines and procedures to resolve issues related to patient's eligibility coverage, and issues arising from in-network/out-of-network status for patients using Advocate's network.
Communicate timely with operations, other patient accounts staff, and customer relations regarding eligibility to facilitate continuity of care with minimal financial risk.
Post benefits information in the appropriate place as established by workflow.
When Transfer of Care is identified, coordinate with other staff including clinical and non-clinical staff from hospitals or branches to obtain and complete documentation for transfer to Advocate Home Health.
Follow a standardized workflow to support achievement of goals and standards related to referral processing.
Interact with referral sources during referral processing to promote effective communication and monitor adherence to established processes.
Partner with clinical staff to assure accuracy and completeness of referrals, follow-up on issues, and escalate concerns as appropriate.
Adhere to standard operating procedures and maintain expected levels of productivity to assure the best health outcomes for our patients.
Follow established scripting for customer service calls and communicating with referral sources.
Utilize critical thinking skills to identify issues and communicate with one up to promote seamless workflow in referral processing.
Administer reports and maintain files of correspondence, medical records, and other documentation, as appropriate, to report status and to support workflow.
Utilize multiple electronic and telephony systems.
Monitor task reports and respond as needed to process new referrals timely.
Adhere to shift productivity and quality expectations as determined by the department to reduce turnaround time and re-work.
Participate in regular huddle meetings with manager and peers.
Track work completion, communicate productivity at huddles, and identify barriers and successes.
Partner with team members on difficult referrals.
Participate in the peer interviewing process of new candidates.
Serve as a preceptor/mentor for new associates and assist with orientation/training.
Build and maintain relationships with other departments both clinical and non-clinical areas to improve department effectiveness and growth.
Adapt to changing business needs, conditions, and work responsibilities. Cross-train to multiple roles within the department.
Visit referral sources to build relationships and promote communication regarding referral processing requirements.
Collaborate with clinical team members to validate/verify accurate and completeness of referral information collected to assure appropriate processing of referrals.
Perform all other duties as assigned.

Benefits

Compensation Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
Premium pay such as shift, on call, and more based on a teammate's job
Incentive pay for select positions
Opportunity for annual increases based on performance
Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program