Referral Specialist
2 weeks ago
Referral Specialist - Downer's Grove - Orthopaedics
Position Highlights:
- Full-Time, 40 hours
- Hours: Monday-Friday; 7:00am-4:00pm - no weekends, evenings or holidays
- Location: Downer's Grove - possibility of hybrid position with in-office 2x/week and remote 3x/week if able to meet metrics.
- Comprehensive medical, dental, and vision benefits that include healthcare navigation assistance and medical coverage at 100% (after deductible) when utilizing a Duly provider.
- Employer provided life and disability insurance.
- $5,250 Tuition Reimbursement per year.
- Immediate 401(k) match.
- 40 hours paid volunteer time off.
- A culture committed to Diversity, Equity, and Inclusion (DEI) and Social Impact.
- 12 weeks parental leave at 100% pay and a financial benefit for adoption and surrogacy for non-physician team members.
Responsibilities
Under direct supervision of the Department Supervisor, the Referral Specialist will be responsible for:
- Receives and documents electronic requests for referrals from the Orthopaedic department providers.
- Contacts review organizations and insurance companies to obtain prior approval requirements and submit appropriate documentation.
- Verifies member eligibility and basic benefit coverage levels including obtaining information on coordination of benefits and third party liability as appropriate.
- Maintains a current working knowledge of all Health Plan carrier requirements for referral request authorizations and approval path requirements. (Pre-Determinations and Peer to Peers
- Provides source of referral and prior approval requests with timely notification of approval or denial decisions through designated communication routes.
- High School Diploma or Equivalent required
- Strong customer service focus
- Effective verbal and written communication skills
- Organized and able to manage competing priorities
- Knowledge of Epic system preferred
- Knowledge and understanding of the medical insurance industry and health plans
- Proficient computer navigation skills, with basic/advanced Microsoft Office/Outlook and intra/internet experience
- Medical Terminology Knowledge preferred
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