Referral Coordinator-Full Time-Chicago

Department:

01120 AMG Chicago N Kedzie - Family Medicine

Status:

Full time

Benefits Eligible:

Yes

Hours Per Week:

40

Schedule Details/Additional Information:

Monday through Friday- 8:00am-4:30pm

Pay Range

$21.45 - $32.20

Address: 1273 N Milwaukee Ave. Chicago, Il 60622 &

2511 N. Kedzie Blvd. Chicago, Il 60647

Hours: Monday Through Friday- 8:00am-4:30pm

Major Responsibilities:

Coordination of the Referral Process

• Completes any pending referrals in EPIC workqueue daily.
• Works in all aspects of the referral process, including processing referrals for patients based on primary care physician orders and follow up specialists service recommended.
• Generates necessary correspondence or calls to patients, physicians and office staff, managed care organizations or vendors requesting additional information and requirements for referral authorization.
• Communicates with appropriate Physician, nursing staff and patients regarding follow-up status of referrals.
• Prepare correspondence, input referral information in the automated system, collects additional medical necessity supporting documentation and provide to appropriate parties for approval.
• Attend Area and Revenue Cycle, and other vendor meetings as required to discuss changes in processing requirements.
• Identifies potential problems (i.e., labs, x-rays, procedures, and other physicians) with payment of charges from referral by communication with Area and other managed care specialists.
• Reviews all payor requirements by type of service and organizes materials to ensure appropriate referral and that steps are followed to avoid claims denials.
• Investigates diagnosis codes and medical necessity guidelines to determine if appropriate based on payor guidelines.
• Discusses any discrepancies with physician for correct coding of referral.
• Monitors approval status and resubmit request as necessary.
• Identifies need for appeal process with insurance companies and Medicare and initiates process.

Participate in education and eligibility problem resolution.

• Works with Clinicians and Clinical Teammates in the education of physician office staff on referral procedures.
• Acts as a resource to patients and help resolve referrals, claims and eligibility issues.
• Communication with Administrative Supervisor, Manager, other health care professionals, and various staff in a positive fashion in order to promote patient satisfaction, quality services delivered and resolution of issues.
• Verify eligibility of patients including problem resolution with Advocate Health and various managed care organizations.
• Identifies and maintains appropriate communication with supervisor involving problems and observations in course of daily operations.
• Other duties as needed.

Assures that referral documentation is filed in the medical record and clinical results forwarded to the Clinician:

• Collect all faxed or mailed in consultant requests.
• Sort and place in physician mailboxes for review with patient chart.
• Assure that physician has signed off acknowledging review.
• Scan necessary documentation regarding referrals as indicated by HIM workflow.

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.