Referral Specialist

2 weeks ago


Downers Grove, United States Duly Health and Care Full time
Overview

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.
Benefits:
  • 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.
The Referral Specialist is responsible for referral/authorization requests for the Orthopaedic department. The Referral Specialist is responsible for processing internal and external referrals requests for injections and surgeries. They will also be responsible for obtaining and submitting medical records, verification of eligibility, and obtaining benefit coverage determinations.

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.
Qualifications
  • 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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