Referral Processing Specialist

American Addiction Centers•Milwaukee, WI

20d•$21 - $31•Remote

About The Position

Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits. This is Transformation One shared purpose brought us together. Now, as one of the 10 largest not-for-profit, integrated health systems in the United States, our combined strength and stability drives us forward. Starting with You Caring for nearly 3 million people has inspired a transformation. One in which the patient’s experience guides our vision and empowers us to offer new possibilities in our communities. Reshaping Access What is access? It’s offering more sites of care than any other health system in the Midwest. But there’s a new frontier. Access is exploring the latest technologies to deliver care to patients exactly where they are and exactly when they need it Inspiring Professionals With our dynamically inclusive workforce and strong connections to the places where we live and work, we’ll touch more lives and contribute to stronger and more vibrant communities. Transforming Care We’re redefining the standard for care with world-class doctors and caregivers, innovative solutions, outstanding outcomes, and leading-edge research and clinical trials. Combined, Advocate and Aurora are recognized for clinical excellence in: Cardiovascular Care Neurosciences Gynecology Oncology Pediatrics Primary Care Neurology Geriatrics Trauma Care

Requirements

HS diploma
2 years of experience in a medical office setting
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 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 in order to achieve and maintain exceptional levels of performance that includes customer service.
Screens and troubleshoots phone calls from referral sources and routes concerns to appropriate department or leadership.
Orders and maintains office supplies, forms and equipment as needed.
Assist with report monitoring and follow-up on pending patients.
Maintains effective communication with referral sources, physicians, home care liaisons and intake RNs to ensure adherence to company policies, guidelines and processes.
Maintains knowledge of all insurance plans including Medicare, Medicaid, and Managed Care procedures and guidelines. When entering referral, 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 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.
Follows a standardized workflow to support achievement of goals and standards related to referral processing.
Interacts with referral sources during referral processing to promote effective communication and monitors adherence to established processes.
Partners with clinical staff to assure accuracy and completeness of referrals, follows-up on issues and escalates concerns as appropriate.
Adhere to standard operating procedures and maintain expected levels of productivity to assure the best health outcomes for our patients.
Follows established scripting for customer service calls and communicating with referral sources.
Utilizes critical thinking skills to identify issues and communicate with one up to promote seamless workflow in referral processing.
Administers reports and maintains files of correspondence, medical records, and other documentation, as appropriate, to report status and to support workflow.
Utilizes multiple electronic and telephony systems.
Monitor task reports and respond as needed to process new referrals timely.
To reduce turnaround time and re-work adhere to shift productivity and quality expectations as determined by department.
Participate in regular huddle meetings with manager and peers.
Track work completion, communicate productivity at huddles and identify barriers and successes.
Partners with team members on difficult referrals.
Participates in peer interviewing process of new candidates.
Serves as a preceptor/mentor for new associates and assists 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.
Visits 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

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:
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
Benefits and more 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

Stand Out From the Crowd

Upload your resume and get instant feedback on how well it matches this job.

Upload and Match Resume