Referral Processing Specialist

Aurora Health Care; Green Bay (WI); On-site; USD 48,712,000 - 63,039,000; Full time

Job summary

Aurora Health Care in Green Bay, WI seeks an Intake Coordinator to collect and record medical, social and reimbursement data to initiate home health, palliative and hospice services. You will handle calls, complete intake forms, process referrals and document service requests to coordinate care.

You will collaborate with nursing staff on physician orders, communicate updates to care teams, and ensure compliance with CMS and payer requirements.

Qualifications

• Basic medical knowledge required.
• Strong verbal and written communication skills.
• Excellent interpersonal skills for interacting with internal and external customers.
• Demonstrated ability to work well with physicians and other professionals.
• Proficient computer skills including word processing and email.

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, including intake forms and referrals.
• Collaborates with nursing staff when reviewing physician orders for plan of care and directs patients to appropriate service departments.
• Communicates and documents updated information, orders or referrals to relevant departments to ensure quality of care and safety.
• Responds to inquiries about Aurora at Home services and programs; explains CMS criteria and refers requests as appropriate.
• Maintains knowledge of Medicare, Medicaid and payer requirements and changes.

Skills

Medical knowledge

Communication skills

Interpersonal skills

Teamwork

Computer skills

Detail-oriented

Education

High School Graduate

Job description

• 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.

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.