Referral Specialist jobs in Wisconsin

Referral Specialist processes insurance pre-verification for hospital admissions or specialty service office visits. Gathers pertinent information from patients, insurance carriers, financial counselors, and other staff to confirm the patient's financial obligations for services. Being a Referral Specialist acts as a liaison between hospitals, clinical staff, health plans, providers, and patients to process referrals. Verifies insurance coverage and obtains required authorizations. Additionally, Referral Specialist resolves pre-certification, registration, and case-related issues. Documents referrals, communications, actions, and other data in an information system. Generates and distributes all applicable forms, notifications, and paperwork. May require an associate degree. Typically reports to a supervisor. The Referral Specialist works under moderate supervision. Gaining or has attained full proficiency in a specific area of discipline. To be a Referral Specialist typically requires 1-3 years of related experience. (Copyright 2024 Salary.com)

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Referral Specialist
  • CenterWell
  • UNKNOWN, WI FULL_TIME
  • Become a part of our caring community and help us put health first

    The E-Referral Specialist is an integral part of the referral process as this role is the initial contact point for the client or referral source to promote the continuity of care. The role is responsible for data collection and documentation, compliance, and consistent follow up on the initial referral process and decision.

    Essential Functions:

    • Monitor multiple e-referral systems to identify new referrals and manage alerts and notifications.
    • Monitor email continuously for request to pull referrals from all applicable referral systems. Perform timely follow-up and manage all related communication.
    • Quickly scan documentation to determine patient eligibility for services (service area, orders, insurance, etc.)
    • Assists, as needed, with authorizations to ensure all are submitted in a timely manner.
    • Monitors status of all referrals received, follow up with each throughout process, reports on status weekly.
    • Communicate with branch, sales, leadership via email and/or phone for status updates and referral decisions as required.
    • Daily manage and update ERST log with all referrals and ROCs decisions.
    • Maintain acceptable productivity level, as determined by work assignment and departmental standards.
    • Comply with and adhere to all regulatory compliance areas, policies and procedures and company best practices.


    Use your skills to make an impact

    Required Experience/Skills:

    • High School Diploma or its equivalent; Associates degree preferred
    • LPN preferred
    • Healthcare insurance verification experience preferred
    • Minimum 1 year customer service or other healthcare related experience; preference working with electronic referrals for Home Health
    • Good knowledge of the issues related to the delivery of home health services
    • Working knowledge of Medicare enrollment and guidelines governing home health agencies preferred
    • Demonstrated ability to type 40 wpm
    • Ability to comprehend and apply principles of basic math while analyzing data and generating reports
    • Good logical thinking and decision making skills
    • Able to work well under pressure and adhere to strict timelines
    • Possess excellent customer service skills; ability to communicate professionally and effectively with all levels of management
    • Strong attention to detail with ability to multi-task and work with multiple screens/systems
    • Good time management skills and are able to work in a fast-paced environment
    • Strong adaptability to change
    • Must read, write and speak fluent English
    • Must have good and regular attendance
    • Approximate percent of time required to travel: 0%
    • Performs other related duties as assigned
    • Weekend coverage required every 4 weeks

    Scheduled Weekly Hours

    40

    Pay Range

    The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay decisions will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

    $34,500 - $47,400 per year


    Description of Benefits

    Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.


    About us

    About CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers – all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives.

    About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation’s largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first – for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.


    Equal Opportunity Employer

    It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.


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  • 1 Day Ago

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Referral Specialist
  • Bedrock Healthcare
  • Madison, WI FULL_TIME
  • Benefits of the Referral Specialist position: Health Insurance Paid Time Off Great Work Environment 401k matched at 10% Flexible Hours (8 hour shifts) Paid Holidays Our Bedrock Health Care Centers mak...
  • 3 Days Ago

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Referral Specialist
  • Bedrock Healthcare
  • Milwaukee, WI FULL_TIME
  • Benefits of the Referral Specialist position: Health Insurance Paid Time Off Great Work Environment 401k matched at 10% Flexible Hours (8 hour shifts) Paid Holidays Our Bedrock Health Care Centers mak...
  • 10 Days Ago

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Referral Specialist
  • Illuminus
  • Berlin, WI FULL_TIME
  • Job Description Job Description Description : LindenGrove Communities in New Berlin is looking for a Part Time (or PRN) Referral Specialist to support our Admissions! Job Type : PRN or Part Time (0.2)...
  • 1 Month Ago

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Referral Specialist II (US)
  • Elevance Health
  • Wisconsin, WI FULL_TIME
  • Job Description Referral Specialist Location : Remote must live within 50 miles from a Pulse Point A proud member of the Elevance Health family of companies, Carelon Behavioral Health, formerly Beacon...
  • 24 Days Ago

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Referral Specialist / Social Worker
  • Illuminus
  • Hazel, WI FULL_TIME
  • DescriptionSt. Dominic Villa, an Illuminus Community, is seeking a highly organized and compassionate individual to join our team as full-time Referral Specialist/Life Coach (Social Worker). In this r...
  • 26 Days Ago

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Referral Specialist
  • Connecticut Institute For Communities Inc.
  • Danbury, CT
  • Connecticut Institute for Communities, Inc. Description: Job Description: Medical Referral Specialist We are seeking a c...
  • 3/28/2024 12:00:00 AM

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Referral Specialist (remote)
  • Morgan Stephens
  • Bethesda, MD
  • Job Title: Remote Referral Specialist Hours: Monday - Friday Two shifts: 7:30am - 4pm or 9am - 5:30pm Location: Full rem...
  • 3/28/2024 12:00:00 AM

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Admissions Referral Specialist
  • UHS
  • Doylestown, PA
  • Responsibilities We are currently hiring a full-time Admissions Referral Specialist to join our Intake team! We offer fl...
  • 3/28/2024 12:00:00 AM

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Referral Specialist
  • Catholic Health Initiatives
  • Minot, ND
  • **Overview** CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. Wi...
  • 3/27/2024 12:00:00 AM

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Referral Specialist
  • UCHealth
  • Aurora, CO
  • Description Location: UCHealth UCHlth 2450 Peoria Admin Services, US:CO:Aurora Department: UCHlth Patient Line Referrals...
  • 3/26/2024 12:00:00 AM

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Referral Specialist Primary Care
  • UHS
  • Aiken, SC
  • Responsibilities ABOUT AIKEN PHYSICIANS ALLIANCE Aiken Physicians Alliance is affiliated with Aiken Regional Medical Cen...
  • 3/26/2024 12:00:00 AM

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Claims Referral Specialist I
  • LIBERTY Dental Plan
  • Tustin, CA
  • Job Details Job Location LIBERTY Dental Plan of California - Tustin, CA Remote Type Hybrid Position Type Full Time Job S...
  • 3/26/2024 12:00:00 AM

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Referral Specialist (Accordia Pediatrics)
  • AltaPointe Health
  • Mobile, AL
  • Overview: Explore our job opportunities at AltaPointe.org, submit your online application, and then join us for Open Int...
  • 3/25/2024 12:00:00 AM

Wisconsin is bordered by the Montreal River; Lake Superior and Michigan to the north; by Lake Michigan to the east; by Illinois to the south; and by Iowa to the southwest and Minnesota to the northwest. A border dispute with Michigan was settled by two cases, both Wisconsin v. Michigan, in 1934 and 1935. The state's boundaries include the Mississippi River and St. Croix River in the west, and the Menominee River in the northeast. With its location between the Great Lakes and the Mississippi River, Wisconsin is home to a wide variety of geographical features. The state is divided into five dist...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Referral Specialist jobs
$39,471 to $48,556

Referral Specialist in Paramus, NJ
The information and referral series is designed to promote public access to a variety of services available through local agencies and programs.
January 20, 2020
Referral Specialist in Clarksville, TN
These referrals are for individuals requiring services related to quality early learning and licensed child care, and children, youth, and adults with developmental disabilities including Coordinated Information Peel, Respite Services and Kids Pathways Peel.
January 29, 2020
Referral Specialist in Fairbanks, AK
A referral specialist may be required to communicate via email and letter, phone, or in person.
December 12, 2019