Referral Specialist

Department:

37394 Advocate Illinois Masonic Medical Center - Infusion: Park Ridge

Status:

Full time

Benefits Eligible:

Yes

Hours Per Week:

Schedule Details/Additional Information:

Monday- Friday 8:30 am- 5:00 pm

Pay Range

$ $32.20Major Responsibilities:
Conducts case by case financial evaluation of all admissions in order to promote funding our future.
4)Works closely with outside firms for Self Pay, eligibility and liability collections to integrate work flow to enhance collections and ensure patient satisfaction.

5)Reviews documentation in order to prepare a written summary outlining the patient's financial situation to be reviewed by the Business Services Supervisor.

6)Assists patients in resolving issues with third party payors that would delay payment from their insurance carriers. Delays can be caused by claims forms, cob forms or liability information.

7)Contacts the attending physician when patients are "out-of-plan" or coverage issues. has been terminated by their insurance carrier.

8)Counsels patients on the specific requirements of their insurance plans related to the treatments planned for the cancer center. Counsels patients on resources to meet financial challenges.

2)Screens patients through financial interview to determine if the patient meets eligibility requirements for possible assistance through the Illinois Department of Public Aid aka Department of Human Service Medical Assistance Program MANG program or IBCCP Illinois Breast and Cervical Cancer Program.

3)Maintains thorough knowledge of Allegra strategies and account flow to ensure specific accounts are correctly classified with appropriate strategy, collector ID, stop statement and vendor codes to avoid incorrect, delayed or premature transfer to a third party or bad debt firm

9)Completes QCLs and other related work requests in a timely fashion

10)Evaluates the patient's financial needs as it relates to the services they will be receiving at the cancer center. This position must understand what the patient may need from the AMG and AIMMC teams with regard to financial advocacy.

1)Screens and financially evaluates patients who are referred by physicians, social service or other hospital departments to determine if they meet financial requirements to qualify for discounted or charity rates or medicaid.

Provides consistently accurate counseling to patients related to insurance verification, cash collections and referral processing to promote growth.
1)Accurately asks patients to provide us the correct demographic information and enter information in system accurately. Responsible for verify insurance coverage, gather referrals, collect copayments and enter into patient EMR/ IDX system.

2)Educates patient on referrals and copayments that needs to be collected at the time of service. Collects all copayments and referrals and enter into AMG and Mosiaq system at the time of service.

3)Ensures all patients seen with HMO insurance have a valid referral at the time of service. Responsible for closely working with case manager to assist with any referral issues.

4)Educates patients on their specific insurance provider guidelines and counsels patients on their financial responsibilities.

5)Facilitates communication with external resources to assist patients in meeting financial needs to optimize collections.

6)Responsible for setting up payment options for certain services and procedure.

8)Collaborates with the Business Services Supervisor to create patient education materials related to financial challenges.

9)Responsible for working with Patient Access Representative and Case Management Department regarding follow up status on referrals daily.

10)Responsible for obtaining referral for outpatient services and procedures from PCP in a timely manner

7)Assists the Business Services Supervisor with creation and maintenance of productivity statistics for the department.

Communicates and documents patient's financial status and related interventions to the rest of the care team by submitting timely entries into the EMR and utilizing other communication tools to promote physician and associate engagement
1)Scans all relevant documents into the EMR per department standards

2)Attends relevant case conference meetings to gain patient referrals and be a resource to physicians and staff

3)Refers patients to Financial Navigator as appropriate for insurance options available for patients

4)Collaborates with Case Managers, SW to promote financial advocacy for our patients

5)Provides educational inservices to physicians and associates to update the team on any issues that relate to financial advocacy.

6)Collaborates with both the AMG and AIMMC financial teams and other caregivers to assure financial advocacy for our patients

7)Responsible for making financial arrangements with self pay and insured patients who are being transferred from other hospitals when referred by on staff physicians in accordance with the hospital's and physican credit and collection policy

8)Conduct financial interviews with patients who request or appear to be eligible for charity consideration through the AMG or AIMMC charity programs. Refer patients as appropriate to departments for assistance.

9)Report monthly statistic on patients to supervisor

10)Ensure all referral obtained for all services are logged and scanned in all appropriate systems in a timely manner.

Attends AMG and AIMMC meetings related to financial advocacy to keep current on knowledge of technical systems and regulations.
1)Attend monthly Cancer Center and departmental meeting.

2)Communicate to staff any insurance changes and updates for AIMMC and AMG departments. Such as policy that are no longer active.

Education/Experience Required:
. High school diploma or equivalent. Bachelor's Degree preferred years in a medical setting or equivalent. 2-3 years of customer service experience in a high volume, multiple task, high stress environment. Plus 1 year hospital or medical office collections or financial counseling experience .Experience handling difficult callers, customers and patients. . Basic knowledge of managed care and commercial insurance. . Basic knowledge of medical terminology and billing and coding practices. . Familiarity with all third party payors . Familiarity with IDPA eligibility for the MANG program . Previous verification experience

Knowledge, Skills & Abilities Required:
. Excellent communication and customer service skills. . Demonstrates excellent ability to establish and maintain effective personal relationships. . Comprehensive ability to conceptualize and follow office policies and procedures. . Ability to handle stressful situations. . Able to function in a high-volume, multiple task environment producing quality work. . Able to work independently and problem solve. . Strong interpersonal and telephone communication skills. . Solid PC skills. .Working knowledge of automated appointment scheduling. . Previous experience with Allegra or patient accounting information system. . Experienced in PC and Windows applications and Microsoft Excel
None

Physical Requirements and Working Conditions:
Demonstrates tact and good judgment. Mature, motivated, decisive and flexible. Professional demeanor. Ability to work in a diverse professional and patient population. Ability to work under stressful conditions and with demanding customers. Bilingual in Spanish preferred. Excellent communications skills strong analytical skills- strong interpersonal skills-ability to work independently-ability to make decisions
If position has direct patient care or direct patient contact the following lifting requirement supersedes any previous lifting requirement effective 06/01/2015. Ability to lift up to 35 pounds without assistance. For patient lifts of over 35 pounds, or when patient is unable to assist with the lift, patient handling equipment is expected to be used, with at least one other associate, when available. Unique patient lifting/movement situations will be assessed on a case-by-case basis.

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.

Our Commitment to You:

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:

Compensation

• Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
• Premium pay such as shift, on call, and more based on a teammate's job
• Incentive pay for select positions
• Opportunity for annual increases based on performance

Benefits and more

• Paid Time Off programs
• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
• Flexible Spending Accounts for eligible health care and dependent care expenses
• Family benefits such as adoption assistance and paid parental leave
• Defined contribution retirement plans with employer match and other financial wellness programs
• Educational Assistance Program

About Advocate Health 

Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation's largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.

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