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JOB LISTING: Full Cycle Medical Referral Specialists: Downers Grove, IL; Long term contract

Full Cycle Medical Referral Specialists: Downers Grove, IL; Long term contract

 

Our client, a very large physician group with a management office in Downers Grove, is seeking multiple Full Cycle Referral Specialists on a temporary (possibly temp-to-hire) basis. 

 

SUMMARY OF POSITION

  • This position is not verifying eligibility!!  It is full cycle referral processing
  • Production expectations 30-35 per day (150-175/week)
  • Expect referrals to be processed in 24-48 hours
  • Training will occur the first week of employment
  • Full cycle referral processing includes the following steps
  • Initiating cases & confirming demographic information
  • Confirming ICD-10 and CPT codes (must be familiar with medical terminology)
  • Reaching out to the health plans to secure approval/authorization
  • Transmitting the authorization to the physician

 

ESSENTIAL DUTIES AND RESPONSIBILITIES:

  • Receives and documents, telephonic, and electronic requests for referrals from Primary Care Physicians, Specialists and Ancillary providers.
  • Contacts review organizations and insurance companies to obtain prior approval requirements and submit appropriate documentation.
  • Verifies member eligibility and basic benefit coverage levels including obtaining information on coordination of benefits and third-party liability as appropriate.
  • Per referral guidelines evaluates each referral request to ensure the referral request including codes, place of service, service type, provider and all required medical information is available for submission to insurance carriers.
  • Performs data entry/processing of referral requests through the EPIC system (Tapestry Module),

 

KNOWLEDGE SKILLS AND ABILITIES:

  • High School diploma required; College Education preferred
  • Strong customer service focus & communication skills
  • Working knowledge of Epic system preferred
  • Working knowledge and understanding of the medical insurance industry and health plans

 

This is a full-time, temporary position that will work from 8:30am-5:00pm. If you or anyone you know is interested, qualified and available please email a résumé to us for immediate consideration.

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(This job listing is assigned to be sent to: Elizabeth.)

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