Monday through Friday- 8:00am-4:30pm

Address: 1273 N Milwaukee Ave. Chicago, IL 60622 &

2511 N. Kedzie Blvd. Chicago, IL 60647

Hours: Monday through Friday- 8:00am-4:30pm

Major Responsibilities:

Coordination of the Referral Process

• Completes any pending referrals in EPIC workqueue daily.
• Works in all aspects of the referral process, including processing referrals for patients based on primary care physician orders and follow up specialists service recommended.
• Generates necessary correspondence or calls to patients, physicians and office staff, managed care organizations or vendors requesting additional information and requirements for referral authorization.
• Communicates with appropriate Physician, nursing staff and patients regarding follow-up status of referrals.
• Prepare correspondence, input referral information in the automated system, collects additional medical necessity supporting documentation and provide to appropriate parties for approval.
• Attend Area and Revenue Cycle, and other vendor meetings as required to discuss changes in processing requirements.
• Identifies potential problems (i.e., labs, x-rays, procedures, and other physicians) with payment of charges from referral by communication with Area and other managed care specialists.
• Reviews all payor requirements by type of service and organizes materials to ensure appropriate referral and that steps are followed to avoid claims denials.
  • Investigates diagnosis codes and medical necessity guidelines to determine if appropriate based on payor guidelines.
  • Discusses any discrepancies with physician for correct coding of referral.
  • Monitors approval status and resubmit request as necessary.
  • Identifies need for appeal process with insurance companies and Medicare and initiates process.

Participate in education and eligibility problem resolution.

• Works with Clinicians and Clinical Teammates in the education of physician office staff on referral procedures.
• Acts as a resource to patients and help resolve referrals, claims and eligibility issues.
• Communication with Administrative Supervisor, Manager, other health care professionals, and various staff in a positive fashion in order to promote patient satisfaction, quality services delivered and resolution of issues.
• Verify eligibility of patients including problem resolution with Advocate Health and various managed care organizations.
• Identifies and maintains appropriate communication with supervisor involving problems and observations in course of daily operations.
• Other duties as needed.

Assures that referral documentation is filed in the medical record and clinical results forwarded to the Clinician:

• Collect all faxed or mailed in consultant requests.
• Sort and place in physician mailboxes for review with patient chart.
• Assure that physician has signed off acknowledging review.
• Scan necessary documentation regarding referrals as indicated by HIM workflow.

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.