Referral Specialist - Park Ridge GI, IL

Centinela Hospital Medical Center; Park Ridge (IL); On-site; USD 10,000 - 60,000; Full time

Job summary

A leading healthcare provider is seeking a Referral Specialist to act as a liaison between insurers and patients. This role involves scheduling referrals, handling prior authorizations, and ensuring a positive experience for patients. With a focus on customer service, the Specialist will navigate healthcare processes and support patients effectively.

Benefits

Paid Time Off

401K Retirement Plan

Medical, Dental, and Vision Coverage

Tuition Reimbursement

Qualifications

• 2 years experience in a clinic work environment preferred.
• Knowledge of prior authorizations and insurance plans.
• Ability to act as a patient liaison and navigate the healthcare system.

Responsibilities

• Acts as a liaison between insurance, healthcare providers, and the clinic.
• Schedules referrals and communicates with patients.
• Reviews clinical data to report medical necessity to insurance companies.

Skills

Customer Service

Organization

Telephone Etiquette

Knowledge of Medical Terminology

Education

Completion of Medical Assistant Program

Tools

Electronic Medical 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 the clinics, referred to 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 authorization 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 and tests/surgeries along with insurance plans. This person should demonstrate good telephone etiquette and be able to speak to patients and others in a polite and friendly manner. Be able to navigate through prior authorization with insurance companies and provide patient support by utilizing resources such as sliding fee scale, payment arrangements, etc. 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 experience in a clinic work environment preferred.
2. Knowledge of medical terminology preferred.
3. Completion of medical assistant program desired; Certified within 6 months of hire.
4. Knowledge of Electronic Medical Systems.
5. Excellent phone skills 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 organization skills.
9. Ability to act as a patient liaison to help them navigate the healthcare system.
10. Be a self-starter and able to multi-task.
11. Ability to organize and troubleshoot scheduling and referral issues and have 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 more voluntary benefit options. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $18.15 to $24.42. The exact starting compensation will be determined at the time of hiring, considering factors such as skillset, experience, education, credentials, and licensure.