Referrals Specialist - Full-Time, Days

The Referrals Specialist will be responsible for scheduling clinic appointments generated from referrals, facilitating scheduling for hospital-based services, obtaining financial clearance, and indicating if the services are financially cleared before the service date. Additionally, they will perform all clerical processing for completion and disposition of assigned accounts and handle patient and third-party payer inquiries.

Essential Job Functions

• Performs other clerical duties as assigned by Manager and/or supervisor(s) handle a variety of task with speed, and attention to detail and accuracy
• Refers self-pay patients to Financial Counseling for self-pay screening to determine if the patient is qualified for additional financial assistance
• Refers patient accounts to financial counselors when further explanation/education is needed regarding denied authorizations, out-of-pocket liabilities, coverage options, payment plans, etc.
• Requires the ability to sufficiently understanding insurance protocols for referrals, co-payments, deductibles, allowances, etc., and analyzes information received to determine patients’ out-of-pocket liabilities
• Run medical necessity as needed per payer
• Communicates the estimated out of pocket liability for the visit
• Documents the hospital operating system with all pertinent information to support the claim if applicable. This includes the reference number of the person you spoke with at the insurance company, the name, pending authorization, clinical information for clinical documentation, etc.
• Handling phone calls from insurance companies, doctor offices and internal departments
• Staying abreast of all insurance verification rules and regulations
• Stays informed of state and federal regulations in relation to hospital reimbursement, and maintains communication with personnel in HIM departments and the business office to ensure accurate reimbursement
• Secure all required clinical documentation needed to obtain the authorization
• Maintain that all encounters needing verification is completed within 48 hours
• Notify the patient as well as the ordering provider if an authorization has been delayed and work with the department to reschedule the services until the authorization of financial clearance has been obtained
• Responsible for obtaining daily work list assigned to the employee to begin scheduling and financial clearance process prior to the date of service
• Scheduling all physician consults generated from the PHA practices and capturing the referral in network
• Obtaining the authorization for the services rendered to ensure proper reimbursement and denial mitigation
• Handles all add-ons as assigned per work list, this includes STAT cases that need to be worked as priority per department policy
• Secure all required clinical documentation needed to obtain the authorization
• Maintain that all encounters needing verification is completed within 48 hours

• High school diploma or equivalent
• Two to three years of demonstrated hospital and patient accounts experience with extensive knowledge in third-party payor/regulatory agency requirements and general medical terminology
• Excellent customer service skills
• Good analytical and problem-solving ability
• Experience in basic computer software programs (Microsoft Word, Excel and Out Look)
• Typing required (minimum 25-30 wpm)

• Previous epic experience

Position Details:

• Job Type/FTE: Full Time (1.0 FTE)
• Shift: Days
• Work Location: Onsite - Burr Ridge
• Unit/Department: Administration
• CBA Code: Non-Union