Referral Specialist

7 days ago


La Grange Park, Illinois, United States Duly Health and Care Full time

Overview:

Referral Specialist - Downer's Grove - Orthopaedics

Position Highlights:

  • Full-Time, 40 hours/week
  • Hours: Monday-Friday 7:00am-4:00pm
  • Location: Downer's Grove

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.

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

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