Requisition ID: 65096

Ministry: Presence Medical Group N/T

Location: Dempster Offices

Location Address:
2380 East Dempster Street, Des Plaines, IL 60016-4839 United States (US)

Department: 10120350 Referral Management RMG

Daily Hours: 8
Standard Hours: 40
Employment Status: Full-time
Employment Type: Regular
Shift: Day
FLSA: N

The Referral Coordinator works under the direction of the Manager, Referral Management to ensure patients receive medically necessary care consistent with the guidelines of the Health Plans and Amita Health.

Coordinates the intake, processing and dissemination of all pre-certification requests. Provides support and assistance in obtaining medical, demographic, eligibility and insurance information necessary to complete the pre-authorization process.

Duties & Responsibilities:

• Accepts all pre-certification requests, submitted by fax, mail or telephone. Checks pre-certifications to verify that all pertinent information is complete on request.
• Ensures all pre-certification requests originate from the primary care physician or treating specialist. Verifies eligibility on all pre-certifications.
• Acts as a resource to primary care physicians, specialists, channel and in-network providers, and when necessary tertiary providers.
• Obtains additional information from the primary care physician when necessary or Health Plan requirements and/or as requested by the Manager, Referral Management or Medical Director.
• Obtains authorization from the Managed Care Plans if necessary.

Education and/or Experience:

• High school diploma or equivalent required. Minimum one year of experience in a hospital, physician's office, Independent Practice Association (IPA), or Managed Care Plan required.
• Must be able to work in a fast-paced environment and take on multiple tasks. Knowledge of medical terminology desired.
• Healthcare experience as a Registrar, Patient Services Rep, or Medical Assistant is highly preferred.

Business Unit: Presence Medical Group N/T
Department Name: Referral Management RMG

Job Function: Professional Services