Be a part of a world-class academic healthcare system at UChicago Medicine Care Network as a Referral Specialist with our Orland Park clinic. In this role, the Referral Specialist initiates the insurance verification and scheduling process for all Primary Healthcare Associates (PHA) generated consults and procedural referrals for outpatient services.
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:
- Capture the referral and schedule all physician consults generated from the PHA practices
- Sufficiently understand insurance protocols for referrals, co-payments, deductibles, allowances, etc.
- Ensures all orders are completed accurately and run medical necessity as needed per payer
- Obtain authorization for the services rendered, secure all required clinical documentation needed to obtain the authorization
- Notify the patient and ordering provider of delayed authorizations and reschedule the services until authorization of financial clearance has been obtained
- Complete and maintain encounter verification within 48 hours; handles all add-ons, including prioritizing STAT cases
- Handling phone calls from insurance companies, doctor offices, and internal departments
- Stay abreast of all insurance verification rules and regulations, state and federal regulations concerning hospital reimbursement, and maintain communication with personnel in HIM departments and the business office to ensure accurate reimbursement
- Document the hospital operating system (EPIC) with all pertinent information to support the claim if applicable (i.e., reference numbers and persons spoken to at insurance companies, pending authorizations, relevant clinical information, etc.)
- Analyze information received to determine patients' out-of-pocket liabilities and communicate the estimated out-of-pocket liability for the visit.
- 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
- General working knowledge of computer programs including the Microsoft Office Suite & knowledge of EPIC preferred
- Job Type/FTE: Full Time (1.0 FTE)
- Shift: Evenings – 8 hour shift
- Unit/Department: Administration
- CBA Code: Non-Union
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