Patient Referral Representative - Ortho

2101 Edward Health Ventures; Naperville (IL); On-site; USD 28,000 - 40,000; Full time

Benefits offered by this job

Premium pay for eligible employees

Career Pathways to Promote Growth

Medical, Dental, Vision options

Tuition Reimbursement

Free Parking

Wellness Program

Savings Plan

Health Savings Account Options

Retirement Options with Company Match

Paid Time Off and Holiday Pay

Community Involvement Opportunities

Job summary

2101 Edward Health Ventures in Naperville, IL is seeking a Patient Referral Representative to support clinical operations and patient services. You will review provider orders, determine referrals, authorizations, and pre-certifications per health plan requirements, while delivering excellent customer service in person and over the phone.

You will verify patient information, coordinates with providers and insurance, and document data in Epic with strict HIPAA adherence.

Qualifications

• High School Diploma or GED required.
• Minimum of two years of physician office or physician billing experience.
• Minimum of one year of customer service experience.
• Working knowledge of medical terminology or coding experience.
• Proficient keyboard and computer skills.

Responsibilities

• Reviewing provider orders and determining appropriate referrals, prior authorizations, and pre-certifications per health plan requirements.
• Providing the highest level of customer service on the phone and in person.
• Process referrals to approved, closed or incomplete status per policy.
• Ensure complete and accurate patient registration including demographics and insurance.
• Address questions about referrals and set expectations for the process.
• Research insurance criteria and need for preauthorization using online tools.
• Communicate with insurance companies, patients, physicians, and facilities about authorization.
• Work with providers to ensure correct coding and approval prior to procedures.
• Maintain relationships with hospital departments, health plan reps, and offices to expedite authorization.
• Document all referral information in Epic and protect patient confidentiality per HIPAA.

Skills

Customer service

Communication skills

Medical terminology

HIPAA knowledge

Education

High School Diploma or GED

Tools

Epic

Job description

Hourly Pay Range

$20.29 - $29.42 - The hourly pay rate offered is determined by a candidate's expertise and years of experience, among other factors.

Position Highlights

Position: Patient Referral Representative

Location: 1331 W 75th Street, Naperville, IL

Full Time: 40 hours / week

Office Hours: Varies Monday - Friday 7:30 AM - 5:00 PM.

What you will do

• Reviewing provider orders and/or requesting for patient services and determining appropriate referral, prior authorizations, and pre-certifications process per health plan requirements.
• Consistently providing the highest level of customer service both on the phone and in person.
• Reviews open status referral report/Epic work queues daily and processes referrals to approved, closed or incomplete status based on established policy.
• Ensures complete and accurate registration, including patient demographic and current insurance information.
• Addresses questions and concerns with patients regarding their referrals and sets guidelines and expectations about the EHV referrals process.
• Utilizes online tools to research criteria to verify insurance coverage and need for preauthorization.
• Communicates professionally with insurance companies, patients, primary care physicians, specialists and/or facilities regarding authorization as needed.
• Works with the provider to ensure the procedure has correct coding and is approved prior to initiation of procedure/test/treatment.
• Establishes, develops and maintains good working relationships with hospital departments, health plan representatives and physician office personnel to ensure timely transfer of information to complete the authorization process and promote goodwill.
• Documents all referral information in Epic.
• Ensures strict confidentiality of all health records, member information and meets HIPAA guidelines.

What you will need

• High School Diploma or GED
• Minimum of two years of physician office or physician billing experience
• Minimum of one year of customer service experience
• Working knowledge of medical terminology or coding experience
• Proficient keyboard and computer skills

Benefits (For full time or part time positions)

• Premium pay for eligible employees
• Career Pathways to Promote Professional Growth and Development
• Various Medical, Dental, Pet and Vision options
• Tuition Reimbursement
• Free Parking
• Wellness Program
• Savings Plan
• Health Savings Account Options
• Retirement Options with Company Match
• Paid Time Off and Holiday Pay
• Community Involvement Opportunities

Endeavor Health Overview

Endeavor Health is a fully integrated healthcare delivery system committed to providing access to quality, vibrant, community-connected care, serving an area of more than 4.2 million residents across six northeast Illinois counties. Our more than 25,000 team members and more than 6,000 physicians aim to deliver transformative patient experiences and expert care close to home across more than 300 ambulatory locations and eight acute care hospitals – Edward (Naperville), Elmhurst, Evanston, Glenbrook (Glenview), Highland Park, Northwest Community (Arlington Heights) Skokie and Swedish (Chicago) – all recognized as Magnet hospitals for nursing excellence. For more information, visit www.endeavorhealth.org. When you work for Endeavor Health, you will be part of an organization that encourages its employees to achieve career goals and maximize their professional potential. Please explore our website (www.endeavorhealth.org) to better understand how Endeavor Health delivers on its mission to "help everyone in our communities be their best". Endeavor Health is committed to working with and providing reasonable accommodation to individuals with disabilities. Please refer to the main career page for more information. At Endeavor Health, we are united by a shared commitment to working together to create a culture of connection and belonging—each of us bringing different skills and experiences as we deliver safe, seamless, and personal care. Every person, every time. We are committed to fostering an environment where all team members can be their best, learn, and pursue excellence together.

Equal Opportunity Employment

EOE: Race/Color/Sex/Sexual Orientation/ Gender Identity/Religion/National Origin/Disability/Vets, VEVRRA Federal Contractor.