Referral Specialist - Park Ridge GI, IL

St. Clare's - Denville; Park Ridge (IL); On-site; USD 10,000 - 60,000; Full time

Job summary

A leading healthcare group in Illinois is seeking a Referral Specialist responsible for managing patient referrals, communicating with clinics, and handling insurance prior authorizations. The ideal candidate will have experience in a clinical setting and possess excellent customer service skills. This role is essential in ensuring seamless coordination for specialty medical visits, and offers competitive compensation and benefits tailored to individual needs.

Benefits

Paid time off

401K retirement plan

Medical, dental, and vision coverage

Tuition reimbursement

Various voluntary benefits

Qualifications

• 2 years of experience in a clinical work environment preferred.
• Knowledge of medical terminology preferred.
• Self-starter capable of multi-tasking.

Responsibilities

• Acts as a liaison between insurance, healthcare providers, and the clinic.
• Responsible for scheduling referrals for patients.
• Performs prior authorizations and manages patient communications.

Skills

Communication

Customer Service

Organizational Skills

Detail-Oriented

Education

Completion of a medical assistant program

Tools

Electronic Medical Records systems

Job description

Overview

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

Responsibilities

The following statements are intended to describe the major elements and requirements of the position and should not be taken as an all-inclusive list of responsibilities, duties, and skills required of an individual assigned to this job. Acts as a liaison between insurance, healthcare providers, and the clinic to ensure required referrals have been processed correctly for medical specialty visits. The Referral Specialist is responsible for scheduling referrals for patients at the request of providers and/or staff. Directly communicates with clinics, referred clinics, and patients. Reviews clinical data to report medical necessity to insurance companies. Performs all work in accordance with the mission, vision, and values of the practice. The Referral Specialist makes referrals to specialists for the office practices, along with prior authorizations, and creates positive relationships between the office practices and specialists. Other duties include, but are not limited to, filing/scanning patient reports, retrieving patient records for prior authorizations or medical records, and completing insurance prior authorizations. The Referral Specialist should demonstrate adequate knowledge of the usual terminology of the referral process, tests/surgeries, and insurance plans. This person should demonstrate good telephone etiquette and be able to speak to patients and others in a polite and friendly manner. Able to navigate prior authorization processes with insurance companies and provide patient support using resources such as sliding fee scales and payment arrangements. Conveys a positive image of the organization and maintains an upbeat, customer-friendly attitude for internal and external customers.

Qualifications

EDUCATION, EXPERIENCE, TRAINING

1. 2 years of experience in a clinical work environment preferred.
2. Knowledge of medical terminology preferred.
3. Completion of a medical assistant program desired; certification within 6 months of hire.
4. Knowledge of Electronic Medical Records systems.
5. Excellent phone and customer service skills.
6. Upbeat, positive, customer-friendly attitude towards internal and external customers.
7. Knowledge of prior authorizations and insurance plans.
8. Good organizational skills.
9. Ability to act as a patient liaison to help navigate the healthcare system.
10. Self-starter capable of multi-tasking.
11. Ability to organize and troubleshoot scheduling or referral issues and provide solutions.
12. Detail-oriented.
13. Ability to work in a changing environment.

Prime Healthcare Illinois Medical Group offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many voluntary benefits. The estimated total compensation for this role ranges from $18.15 to $24.42 per hour, including wages, benefits, and other forms of compensation. The exact starting salary will be determined at the time of hire based on factors such as skillset, experience, education, credentials, and licensure.