Referral Specialist - Full-Time, Days - The University of Chicago Medicine

Be a part of a world-class academic healthcare system, UChicago Medicine Care Network, as a Referral Specialist at our Flossmoor clinic. This position is a 100% onsite opportunity. You will need to be based in the greater Chicagoland area.

The Referrals Specialist will be responsible for scheduling clinic appointments generated from referrals, facilitating scheduling for hospital-based services, obtaining financial clearance, and indicating if the services are financially cleared before the service date. Additionally, they will perform all clerical processing for completion and disposition of assigned accounts and handle patient and third-party payer inquiries.

Essential Job Functions

• Performs other clerical duties as assigned by Manager and/or supervisor(s) handle a variety of task with speed, and attention to detail and accuracy

• Refers self-pay patients to Financial Counseling for self-pay screening to determine if the patient is qualified for additional financial assistance

• Refers patient accounts to financial counselors when further explanation/education is needed regarding denied authorizations, out-of-pocket liabilities, coverage options, payment plans, etc.

• Requires the ability to sufficiently understanding insurance protocols for referrals, co-payments, deductibles, allowances, etc., and analyzes information received to determine patients’ out-of-pocket liabilities

• Run medical necessity as needed per payer

• Communicates the estimated out of pocket liability for the visit

• Documents the hospital operating system with all pertinent information to support the claim if applicable.  This includes the reference number of the person you spoke with at the insurance company, the name, pending authorization, clinical information for clinical documentation, etc.

• Handling phone calls from insurance companies, doctor offices and internal departments

• Staying abreast of all insurance verification rules and regulations

• Stays informed of state and federal regulations in relation to hospital reimbursement, and maintains communication with personnel in HIM departments and the business office to ensure accurate reimbursement

• Secure all required clinical documentation needed to obtain the authorization

• Maintain that all encounters needing verification is completed within 48 hours

• Notify the patient as well as the ordering provider if an authorization has been delayed and work with the department to reschedule the services until the authorization of financial clearance has been obtained

• Responsible for obtaining daily work list assigned to the employee to begin scheduling and financial clearance process prior to the date of service

• Scheduling all physician consults generated from the PHA practices and capturing the referral in network

• Obtaining the authorization for the services rendered to ensure proper reimbursement and denial mitigation

• Handles all add-ons as assigned per work list, this includes STAT cases that need to be worked as priority per department policy

• Secure all required clinical documentation needed to obtain the authorization

• Maintain that all encounters needing verification is completed within 48 hours

Required Qualifications

• High school diploma or equivalent
• Two to three years of demonstrated hospital and patient accounts experience with extensive knowledge in third-party payor/regulatory agency requirements and general medical terminology
• Excellent customer service skills
• Good analytical and problem-solving ability
• Experience in basic computer software programs (Microsoft Word, Excel and Out Look)
• Typing required (minimum 25-30 wpm)

Preferred Qualifications

• Previous epic experience

Position Details:

• Job Type/FTE: Full Time (1.0 FTE)
• Shift: Days (8am-5pm)
• Work Location: Onsite - Flossmoor
• Unit/Department: Administration
• CBA Code: Non-Union

We’ve been at the forefront of medicine since 1899. We provide superior healthcare with compassion, always mindful that each patient is a person, an individual. To accomplish this, we need employees with passion, talent and commitment… with patients and with each other. We’re in this together: working to advance medical innovation, serve the health needs of the community, and move our collective knowledge forward. If you’d like to add enriching human life to your profile, UChicago Medicine is for you. Here at the forefront, we’re doing work that really matters. Join us. Bring your passion.

UChicago Medicine is growing; discover how you can be a part of this pursuit of excellence at: UChicago Medicine Career Opportunities.

UChicago Medicine is an equal opportunity employer.  We evaluate qualified applicants without regard to race, color, ethnicity, ancestry, sex, sexual orientation, gender identity, marital status, civil union status, parental status, religion, national origin, age, disability, veteran status and other legally protected characteristics.

Must comply with UChicago Medicine’s COVID-19 Vaccination requirement as a condition of employment. If you have already received the vaccination, you must provide proof as part of the pre-employment process. This is in addition to your compliance with the Flu Vaccination requirement as well. Medical and religious exemptions will be considered consistent with applicable law. Lastly, a pre-employment physical, drug screening, and background check are also required for all employees prior to hire.