Referral Specialist - Orthopaedics
Posted on Oct 10, 2024 by Duly Health and Care
Downers Grove, IL
Health Care
Immediate Start
Annual Salary
Full-Time
Overview:
Referral Specialist - Downer's Grove - Orthopaedics
Position Highlights:
Full-Time, 40 hours
Hours: Monday-Friday; 7:00am-4:00pm - no weekends, evenings or holidays!
Location: Downer's Grove - possibility of hybrid position with in-office 2x/week and remote 3x/week if able to meet metrics.
Benefits:
Comprehensive medical, dental, and vision benefits that include healthcare navigation assistance and medical coverage at 100% (after deductible) when utilizing a Duly provider.
Employer provided life and disability insurance.
$5,250 Tuition Reimbursement per year.
Immediate 401(k) match.
40 hours paid volunteer time off.
A culture committed to Diversity, Equity, and Inclusion (DEI) and Social Impact.
12 weeks parental leave at 100% pay and a financial benefit for adoption and surrogacy for non-physician team members.
The Referral Specialist is responsible for referral/authorization requests for the Orthopaedic department. The Referral Specialist is responsible for processing internal and external referrals requests for injections, surgeries. They will also be responsible for obtaining and submitting medical records, verification of eligibility, and obtaining benefit coverage determinations.
Responsibilities:
The Journeys and Adventures that Await
•Receives and documents 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.
• Maintains a current working knowledge of all Health Plan carrier requirements for referral request authorizations and approval path requirements. (Pre-Determinations and Peer to Peers)
• Provides source of referral and prior approval requests with timely notification of approval or denial decisions through designated communication routes.
Qualifications:
The Experiences You Bring
High School Diploma or Equivalent required
Strong customer service focus
Effective verbal and written communication skills
Organized and able to manage competing priorities
Knowledge of Epic system preferred
Knowledge and understanding of the medical insurance industry and health plans
Proficient computer navigation skills, with basic/advanced Microsoft Office/Outlook and intra/internet experience
Medical Terminology Knowledge preferred
Referral Specialist - Downer's Grove - Orthopaedics
Position Highlights:
Full-Time, 40 hours
Hours: Monday-Friday; 7:00am-4:00pm - no weekends, evenings or holidays!
Location: Downer's Grove - possibility of hybrid position with in-office 2x/week and remote 3x/week if able to meet metrics.
Benefits:
Comprehensive medical, dental, and vision benefits that include healthcare navigation assistance and medical coverage at 100% (after deductible) when utilizing a Duly provider.
Employer provided life and disability insurance.
$5,250 Tuition Reimbursement per year.
Immediate 401(k) match.
40 hours paid volunteer time off.
A culture committed to Diversity, Equity, and Inclusion (DEI) and Social Impact.
12 weeks parental leave at 100% pay and a financial benefit for adoption and surrogacy for non-physician team members.
The Referral Specialist is responsible for referral/authorization requests for the Orthopaedic department. The Referral Specialist is responsible for processing internal and external referrals requests for injections, surgeries. They will also be responsible for obtaining and submitting medical records, verification of eligibility, and obtaining benefit coverage determinations.
Responsibilities:
The Journeys and Adventures that Await
•Receives and documents 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.
• Maintains a current working knowledge of all Health Plan carrier requirements for referral request authorizations and approval path requirements. (Pre-Determinations and Peer to Peers)
• Provides source of referral and prior approval requests with timely notification of approval or denial decisions through designated communication routes.
Qualifications:
The Experiences You Bring
High School Diploma or Equivalent required
Strong customer service focus
Effective verbal and written communication skills
Organized and able to manage competing priorities
Knowledge of Epic system preferred
Knowledge and understanding of the medical insurance industry and health plans
Proficient computer navigation skills, with basic/advanced Microsoft Office/Outlook and intra/internet experience
Medical Terminology Knowledge preferred
Reference: 203995252
https://jobs.careeraddict.com/post/96081285
Referral Specialist - Orthopaedics
Posted on Oct 10, 2024 by Duly Health and Care
Downers Grove, IL
Health Care
Immediate Start
Annual Salary
Full-Time
Overview:
Referral Specialist - Downer's Grove - Orthopaedics
Position Highlights:
Full-Time, 40 hours
Hours: Monday-Friday; 7:00am-4:00pm - no weekends, evenings or holidays!
Location: Downer's Grove - possibility of hybrid position with in-office 2x/week and remote 3x/week if able to meet metrics.
Benefits:
Comprehensive medical, dental, and vision benefits that include healthcare navigation assistance and medical coverage at 100% (after deductible) when utilizing a Duly provider.
Employer provided life and disability insurance.
$5,250 Tuition Reimbursement per year.
Immediate 401(k) match.
40 hours paid volunteer time off.
A culture committed to Diversity, Equity, and Inclusion (DEI) and Social Impact.
12 weeks parental leave at 100% pay and a financial benefit for adoption and surrogacy for non-physician team members.
The Referral Specialist is responsible for referral/authorization requests for the Orthopaedic department. The Referral Specialist is responsible for processing internal and external referrals requests for injections, surgeries. They will also be responsible for obtaining and submitting medical records, verification of eligibility, and obtaining benefit coverage determinations.
Responsibilities:
The Journeys and Adventures that Await
•Receives and documents 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.
• Maintains a current working knowledge of all Health Plan carrier requirements for referral request authorizations and approval path requirements. (Pre-Determinations and Peer to Peers)
• Provides source of referral and prior approval requests with timely notification of approval or denial decisions through designated communication routes.
Qualifications:
The Experiences You Bring
High School Diploma or Equivalent required
Strong customer service focus
Effective verbal and written communication skills
Organized and able to manage competing priorities
Knowledge of Epic system preferred
Knowledge and understanding of the medical insurance industry and health plans
Proficient computer navigation skills, with basic/advanced Microsoft Office/Outlook and intra/internet experience
Medical Terminology Knowledge preferred
Referral Specialist - Downer's Grove - Orthopaedics
Position Highlights:
Full-Time, 40 hours
Hours: Monday-Friday; 7:00am-4:00pm - no weekends, evenings or holidays!
Location: Downer's Grove - possibility of hybrid position with in-office 2x/week and remote 3x/week if able to meet metrics.
Benefits:
Comprehensive medical, dental, and vision benefits that include healthcare navigation assistance and medical coverage at 100% (after deductible) when utilizing a Duly provider.
Employer provided life and disability insurance.
$5,250 Tuition Reimbursement per year.
Immediate 401(k) match.
40 hours paid volunteer time off.
A culture committed to Diversity, Equity, and Inclusion (DEI) and Social Impact.
12 weeks parental leave at 100% pay and a financial benefit for adoption and surrogacy for non-physician team members.
The Referral Specialist is responsible for referral/authorization requests for the Orthopaedic department. The Referral Specialist is responsible for processing internal and external referrals requests for injections, surgeries. They will also be responsible for obtaining and submitting medical records, verification of eligibility, and obtaining benefit coverage determinations.
Responsibilities:
The Journeys and Adventures that Await
•Receives and documents 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.
• Maintains a current working knowledge of all Health Plan carrier requirements for referral request authorizations and approval path requirements. (Pre-Determinations and Peer to Peers)
• Provides source of referral and prior approval requests with timely notification of approval or denial decisions through designated communication routes.
Qualifications:
The Experiences You Bring
High School Diploma or Equivalent required
Strong customer service focus
Effective verbal and written communication skills
Organized and able to manage competing priorities
Knowledge of Epic system preferred
Knowledge and understanding of the medical insurance industry and health plans
Proficient computer navigation skills, with basic/advanced Microsoft Office/Outlook and intra/internet experience
Medical Terminology Knowledge preferred
Reference: 203995252
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