Advocate Health Care · 1 day ago
Referral Specialist- Full-Time- Park Ridge
Park Ridge, IL
Full-time
Onsite
Mid Level
$21/hr - $32/hr
3+ years expAdvocate Health Care is seeking a Referral Specialist to manage and navigate the centralized referral process. The role involves processing referrals, communicating with members and physicians, and coordinating discharge planning to ensure quality care and compliance with coverage guidelines.
Clinical TrialsDeliveryHealth Care
Responsibilities
Works in all aspects of centralized referral process, including processing referrals to members, physicians and specialists, under the direction of the supervisor, RNs and Medical Directors and per medical policies and criteria
Generates necessary correspondence or calls to members, physicians and office staff, managed care organizations or vendors requesting additional information
Communicates with appropriate staff and members regarding follow-up status of referrals
Works with UM staff to file, prepare correspondence, data entry, system documentation and other medical management related activities
Reconciles and investigates the daily pended claims report to ensure the proper payment of claims in a timely manner and utilizes the pended claims report to recognize areas of opportunity to provide outreach to members in an attempt to bring them back into the Advocate network
Coordinates the initial referral and renewal of home care, DME and disposable supplies under the supervision of RN for the outpatient population
Evaluates the cost-effectiveness of DME purchase versus rental
Logs member or physician complaints related to ancillary vendors as well as investigates and documents follow-up of complaints
Responsible for the coordination and monitoring of discharge planning to provide cost effective care and quality outcomes to members in accordance with their benefit coverage guidelines
Works with the Hospital Care Manager to coordinate discharge planning referral needs when indicated
Provides authorization of contracted vendors for home health, DME, Skilled Nursing Facilities, and ambulance referrals
Generates referral authorization for in network specialists as well as diagnostic and imaging requests as defined by the network
Documents in IDX the appropriate referral information in a timely fashion to ensure that claims are processed appropriately and to meet the requirements established for compliance by the payers and CMS
Is responsible for being available telephonically in order to provider referral authorization in a timely fashion to the Hospital Care Manager
Acts as a resource in the education of physician office staff on referral procedures, AHP policies and procedures, and benefit plan limitations as well as a resource to customers and assists in the resolution of referral, claim, and eligibility issues
Communicates with the AMG Case Manager, Supervisor, Manager, Director, other health care professionals, and various staff in a positive fashion in order to promote member satisfaction, quality services delivered, and resolution of issues
Verify eligibility for members including coordination of benefits and third party liability, benefit coverage levels, and problem resolution with Advocate MSO and various managed care organizations
Identifies and maintains appropriate communication with Supervisor regarding problems and observations in the course of daily operations
Qualification
Required
AA Degree or equivalent
3-4 years experience in a managed care organization, hospital or physician's office
Good verbal and written communications skills
Excellent interpersonal communication skills
Ability to work as a team member
Good computer keyboard proficiency
Good organizational skills
Ability to handle difficult calls and maintain professional conduct
Willingness to be flexible with job responsibilities
Ability to work under stressful conditions
Ability to handle stress and high workload volumes
Flexible with work assignments
Ability to communicate denial of services to members and providers
Ability and willingness to be cross-trained in all referral specialist activities
Preferred
Medical record experience preferred and/or medical terminology
Certified Medical Assistant preferred
MRT preferred
Company
Advocate Health Care
Advocate Health Care is an integrated healthcare delivery system based in Illinois, United States.
10001+ employees
H1B Sponsorship
Advocate Health Care has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (26)
2024 (9)
2023 (6)
2022 (16)
2021 (8)
2020 (7)
Funding
Current Stage
Late StageTotal Funding
$18M2013-10-03Series Unknown· $18M
Leadership Team
Barbara Hancock
Executive Assistant to the President and Chief Operating Officer
David Rich
Clinical Practice Partner
Recent News
2025-10-10
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2025-10-09
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2025-10-01
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