Referral Coordinator

2 weeks ago


Chicago, Illinois, United States Advocate Health Full time
Job Summary

We are seeking a highly organized and detail-oriented Referral Coordinator to join our team at Advocate Health. The successful candidate will be responsible for coordinating the referral process for orthopedic surgery patients, ensuring seamless communication between healthcare providers and payors.

Key Responsibilities
  • Coordinate referrals for orthopedic surgery patients, including collecting necessary information and approvals from attending physicians.
  • Process referrals for patients based on primary care physician orders and follow-up specialist services.
  • Generate correspondence and make calls to patients, physicians, and office staff to request additional information and requirements for referral authorization.
  • Communicate with physicians, nursing staff, and patients regarding follow-up status of referrals.
  • Prepare correspondence, input referral information into the automated system, collect additional medical necessity supporting documentation, and provide to appropriate parties for approval.
  • Attend PHO and other vendor meetings to discuss changes in processing requirements.
  • Identify potential problems with payment of charges from referrals and communicate with PHO and other managed care specialists.
Requirements
  • High school diploma or equivalent required.
  • 3-4 years of experience in a managed care organization, hospital, or physician's office with 1 year of referral experience.
  • Excellent medical terminology comprehension and effective usage.
  • Completion of 1 Medical Terminology class with certificate of completion.
Preferred Qualifications
  • Excellent communication and organizational skills.
  • Computer literate with experience with IDX, Windows, and other I.S. systems.
  • Good problem-solving skills and ability to handle difficult calls.
  • Ability to work independently and as part of a team.
Working Conditions
  • Ability to work in a fast-paced environment with high workload volumes.
  • Ability to communicate denial of services to members and providers.

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