Referral Specialist

3 days ago

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

Referral Specialist - Downers Grove - Orthopaedics

Position Highlights:
  • Full-Time, 40 hours/week
  • Hours: Monday-Friday 7:00am-4:00pm
  • Location: Downers Grove; opportunity to work hybrid once metrics met (2 days in office, 3 days remote)
Benefits:
  • Comprehensive medical, dental, and vision benefits that include healthcare navigation assistance.
  • Access to a mental health benefit at no cost.
  • 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 community engagement and social impact.
  • Up to 12 weeks parental leave at 100% pay and a financial benefit for adoption and surrogacy for non-physician team members once eligibility requirements are met.
Responsibilities
  • Receives and documents and electronic requests for referrals from Ortho/Podiatry Providers.
  • 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
  • Prefer one-year experience in customer service setting, preferably in a medical office with basic knowledge of medical and insurance terminology
  • 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


The compensation for this role includes a base pay range of $16.35-24.52 with the actual pay determined by factors such as skills, experience, education, certifications, geographic location, and internal equity. Additional compensation may be available through shift differentials, bonuses, and other incentives. Base pay is only a portion of the total rewards package.

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