Referral Processing Specialist Per Diem

Advocate Health and Hospitals Corporation•Oak Brook, IL

1d•Remote

About The Position

This is a part-time, per diem position within the Patient Access department, focusing on the day-to-day operations of the Customer Service Center. The role involves triaging home health referrals, assembling referral information in the electronic medical record (EMR), processing referrals accurately and efficiently, and screening/troubleshooting calls from referral sources. The specialist will also manage office supplies, assist with report monitoring, and maintain communication with various stakeholders. A key aspect of the role is verifying insurance coverage, benefits, and patient financial responsibilities, ensuring payer requirements are met and coordinating with other departments for continuity of care. The position requires adherence to standardized workflows, effective communication, critical thinking, and proficiency in multiple electronic systems. Teamwork, cross-training, and building relationships with internal and external partners are also essential. Occasional travel to referral locations may be required.

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.

Nice To Haves

Call center experience a plus

Responsibilities

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.