Referral Processing Specialist

Advocate Health; Green Bay (WI); On-site; USD 22,000 - 30,000; Full time

Job summary

Advocate Health is seeking a detail-oriented intake coordinator to support home health, palliative and hospice services. You will collect and record medical, social, and reimbursement data to initiate care and coordinate with clinicians.

The role requires strong communication, data entry skills, and the ability to manage multiple referrals while ensuring compliance with payer guidelines and admission policies.

Qualifications

• Collects and records medical, social and reimbursement data for patient admission to initiate home care, palliative care and hospice.
• Strong verbal and written communication to handle intake, questions, and referrals in a timely, accurate manner.
• Comfort coordinating with clinicians to ensure plan of care is followed and within scope of practice.

Responsibilities

• Collects and records medical, social and reimbursement data for admission to home care, palliative and hospice programs.
• Screens, documents and processes requests for home health, palliative and hospice services, handling intake forms and referrals.
• Collaborates with nursing to review physician orders and direct patients to appropriate service departments.
• Communicates updates and changes to intake data to relevant teams to maintain care quality and safety.
• Responds to inquiries about home services and CMS eligibility and refers to community resources when appropriate.
• Keeps knowledge up to date on Medicare, Medicaid and payer requirements and trends.

Skills

Medical knowledge

Communication

Interpersonal skills

Attention to detail

Organizational skills

Team collaboration

Education

High School Diploma

Tools

EPIC

Job description

Major Responsibilities:

• Collects and records medical, social and reimbursement data pertinent to patient admission to initiate home care, palliative care and hospice.
• Screens, documents and processes requests for home health, palliative and hospice services. This includes taking incoming calls, answering customer questions, completing intake forms, processing referral orders within EPIC or faxed referrals and documenting service requests for coordination of care; including promoting company products and service.
• Collaborates with the nursing team when reviewing and processing physician orders for instructions on patient's plan of care and prior to sending patients to the appropriate patient service department to ensure activities are performed within the scope of practice.
• Communicates and documents any new, changed, updated information, orders or referrals received within intake to the appropriate persons and/or departments as needed to not compromise the quality of care and safety of patient(s).
• Responds to inquiries regarding Aurora at Home services and programs. Explains programs and services, in addition to determining if patients meet criteria for Centers for Medicare & Medicaid Services (CMS) certified agency, admission policies and/or referring requests to other community agencies when appropriate.
• Maintains knowledge of and reference materials of Medicare, Medicaid and third-party payer requirements, payer coverage, guidelines, documentation requirements and insurance related changes or trends.

Licensure, Registration, and/or Certification Required:

• None Required.

Education Required:

• High School Graduate.

Experience Required:

• Typically requires 1 year of experience in a clinical environment.

Knowledge, Skills & Abilities Required:

• Basic medical knowledge.
• Strong verbal and written communication skills a must including experience in data entry, multi-line phone system, and customer service experience.
• Excellent interpersonal skills necessary to interact with internal and external customers.
• Demonstrated ability to work well with physicians and other professionals.
• Proficient computer skills including word processing and electronic mail.
• Must be detail-oriented and have excellent organizational skills.

Physical Requirements and Working Conditions:

• Generally exposed to a normal office environment.
• Must be able to sit for extended periods and may be required to stand, bend, twist, kneel, squat and reach above the shoulders throughout the workday.
• May be exposed to hazardous chemicals, loud noises or hazardous equipment when patient care is involved.
• Position requires travel for education and periodic off site meetings. May be exposed to road and weather hazards.

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.