Referral Processing Specialist

Advocate Health and Hospitals Corporation•Milwaukee, WI

1d•Hybrid

About The Position

This is a 1.0 FTE remote position within the Home Office WI - Patient Access department. The role requires high-speed internet and a quiet workspace. The schedule is Monday-Friday 8:30 AM to 5:00 PM, with rotation for weekends and holidays. The Referral Processing Specialist is responsible for collecting and recording medical, social, and reimbursement data to initiate home care, palliative care, and hospice services. This involves screening, documenting, and processing requests, including taking calls, answering questions, completing intake forms, processing referral orders in EPIC or via fax, and documenting service requests for care coordination. The role also involves promoting company products and services, collaborating with the nursing team on physician orders, communicating updated information, responding to inquiries about services, explaining programs, determining eligibility for CMS-certified agencies, and referring requests to other community agencies when appropriate. Maintaining knowledge of Medicare, Medicaid, and third-party payer requirements is essential.

Requirements

High School Graduate.
Typically requires 1 year of experience in a clinical environment.
Basic medical knowledge.
Strong verbal and written communication skills a must including experience in data entry, multi-line phone system, and customer service experience.
Excellent interpersonal skills necessary to interact with internal and external customers.
Demonstrated ability to work well with physicians and other professionals.
Proficient computer skills including word processing and electronic mail.
Must be detail-oriented and have excellent organizational skills.
Highspeed internet and quiet space to work is required.

Responsibilities

Collects and records medical, social and reimbursement data pertinent to patient admission to initiate home care, palliative care and hospice.
Screens, documents and processes requests for home health, palliative and hospice services.
Takes incoming calls, answers customer questions, completes intake forms, processes referral orders within EPIC or faxed referrals and documents service requests for coordination of care.
Promotes company products and services.
Collaborates with the nursing team when reviewing and processing physician orders for instructions on patient's plan of care and prior to sending patients to the appropriate patient service department to ensure activities are performed within the scope of practice.
Communicates and documents any new, changed, updated information, orders or referrals received within intake to the appropriate persons and/or departments as needed to not compromise the quality of care and safety of patient(s).
Responds to inquiries regarding Aurora at Home services and programs.
Explains programs and services, in addition to determining if patients meet criteria for Centers for Medicare & Medicaid Services (CMS) certified agency, admission policies and/or referring requests to other community agencies when appropriate.
Maintains knowledge of and reference materials of Medicare, Medicaid and third-party payer requirements, payer coverage, guidelines, documentation requirements and insurance related changes or trends.

Benefits

Competitive compensation
Generous retirement offerings
Programs that invest in your career development
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
Other financial wellness programs
Educational Assistance Program