Referral Specialist / Him Lead-Full Time

Advocate Health and Hospitals Corporation•Chicago, IL

9d•Onsite

About The Position

This is a full-time position within the AMG Chicago Ravenswood Ave - Family Medicine department. The role combines responsibilities of a Referral Specialist and a Health Information Lead. The Referral Specialist coordinates patient care needs for high-risk patients, manages the managed care process, handles referral processing, resolves eligibility and denial issues, identifies patients for disease management programs, obtains necessary information for referrals, initiates medical necessity reviews, acts as a patient advocate, handles pre-certification, and educates providers and staff on managed care updates. The Health Information Lead is responsible for maintaining good workflow for Health Information associates, scheduling, assigning tasks, training associates, ensuring accuracy, updating and reviewing compliance of protocols, maintaining the Chart Tracking system, managing requested health information releases, forwarding inactive charts, educating staff on health information (e.g., HIPAA), and providing back-up support for various medical records duties.

Requirements

Completion of an LPN, Medical Assistant program, or equivalent experience.
Successful completion of certification exam for CMA or licensure as an LPN.
3-5 years experience in ambulatory/ medical office.
Clinically appropriate skills.
Ability to communicate clearly and effectively in caring manner.
Strong interpersonal & customer relations skills.
Good verbal and written communication skills.
Ability to work as a team player.
Good organizational skills.
Good problem-solving skills.
Ability to handle difficult calls and maintain professional conduct.
Flexible.
LPN Licensure or Medical Assistant Certification.
Current CPR certification.
Knowledge of Universal precautions, Hazardous Waste procedures.

Nice To Haves

May require evening/Saturday hours to accommodate practice needs.

Responsibilities

Coordinates patient care needs for high-risk patients (including diabetes and preeclampsia), arranging for appropriate referrals and paperwork for specialty physician care, diabetic teaching and nutrition education, home visits, and durable equipment needs.
Responsible for coordination of the managed care process.
Handles referral processing activities from the physician office side, including all paperwork required for working within established PHO procedures.
Works through eligibility and denial issues on behalf of the patient and physician.
Identifies and refers appropriate patients for disease management/case management programs.
Responsible for obtaining needed information to get needed referrals.
Initiates the medical necessity review process as appropriate with the support of the physician.
Acts as a resource (advocate) for patients in working through the managed care process.
Handles the pre-certification process.
Continues to educate providers and clinical staff of managed care updates.
Maintains current skill verification specific to their practice.
Maintains current CPR certification.
Attends in-service and other professional development opportunities.
Maintains CMA re-certification as required.
Responsible for maintaining good workflow for the Health Information associates by scheduling them appropriately to meet budget FTE and assigning assignments.
Responsible for training all Health Information associates and ensures accuracy and completeness of all health information tasks performed by associates.
Updates and reviews compliance of protocols set up for the Family Practice Center Medical Records department.
Responsible for maintaining Chart Tracking system in IDX.
Responsible for all Health Information being requested for Release.
Responsible for forwarding inactive charts to off-site storage area.
Continues to inform and educate clinical staff and providers of health information education (e.g., HIPPA).
Provides back-up support as needed for misc filing, pulling charts, answering phones and performs other Medical Records duties assigned (varies based on practice need).

Benefits

Comprehensive suite of Total Rewards: benefits and well-being programs
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 and other financial wellness programs
Educational Assistance Program