IL Referral Processing Specialist: Full Time Wed-Sun

Major Responsibilities:

• A. Provide support to the day-to-day operations of Customer Service Center.
  •     1)Provide triaging of home health referrals from referral sources received telephonically, electronically or by fax with exceptional customer service.
  •     2)Assemble referral information in the home health electronic medical record (EMR) including monitoring interface of data from other electronic systems.
  •     3)Process referrals in a timely, complete, and accurate manner in order to achieve and maintain exceptional levels of performance that includes customer service.
  •     4)Screens and troubleshoots phone calls from referral sources and routes concerns to appropriate department or leadership.
  •     5)Orders and maintains office supplies, forms and equipment as needed.
  •     6)Assist with report monitoring and follow-up on pending patients.
  •     7)Maintains effective communication with referral sources, physicians, home care liaisons and intake RNs to ensure adherence to company policies, guidelines and processes.
  •     8)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.
  •     1)Identify insurance coverage, benefits available, patient's out-of-pocket costs, co-insurance, co-payment and deductible.
  •     2)Determine if payer's coverage requirements are met for services.
  •     3)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.
  •     4)Communicate timely with operations, other patient accounts staff and customer relations regarding eligibility, to facilitate continuity of care with minimal financial risk.
  •     5)Post benefits information in appropriate place as established by workflow.
  •     6)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.
  •     1)Interacts with referral sources during referral processing to promote effective communication and monitors adherence to established processes.
  •     2)Partners with clinical staff to assure accuracy and completeness of referrals, follows-up on issues and escalates concerns as appropriate.
  •     3)Adhere to standard operating procedures and maintain expected levels of productivity to assure the best health outcomes for our patients.
  •     4)Follows established scripting for customer service calls and communicating with referral sources.
  •     5)Utilizes critical thinking skills to identify issues and communicate with one up to promote seamless workflow in referral processing.
  •     6)Administers reports and maintains files of correspondence, medical records, and other documentation, as appropriate, to report status and to support workflow.
  •     7)Utilizes multiple electronic and telephony systems.
  •     8)Monitor task reports and respond as needed to process new referrals timely.
  •     9)To reduce turnaround time and re-work adhere to shift productivity and quality expectations as determined by department.
• Team Work.
  •     1)Participate in regular huddle meetings with manager and peers.
  •     2)Track work completion, communicate productivity at huddles and identify barriers and successes.
  •     3)Partners with team members on difficult referrals.
  •     4)Participates in peer interviewing process of new candidates.
  •     5)Serves as a preceptor/mentor for new associates and assists with orientation/training
  •     6)Build and maintain relationships with other departments both clinical and non-clinical areas to improve department effectiveness and growth.
  •     7)Adapt to changing business needs, conditions and work responsibilities. Cross-train to multiple roles within the department.
  •     8)Visits referral sources to build relationships and promote communication regarding referral processing requirements.
  •     9)Collaborate with clinical team members to validate/verify accurate and completeness of referral information collected to assure appropriate processing of referrals.
  •     10)Perform all other duties as assigned.

Education/Experience Required:

• • HS diploma • 2 years of experience in a medical office setting • Call center experience a plus • Knowledge of medical terminology and health care industry • Knowledge of Medicare/Medicaid and other third party payers.

Knowledge, Skills & Abilities Required:

• • 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.
• N/A

Physicial Requirements and Working Conditions:

• • 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)

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.