Referral Specialist - Care Coordination

• Basic understanding of symptoms, causes, and treatment of mental health, addiction, and substance use problems to identify the proper location that best fits the consumer's needs and insurance coverage.
• Consistently answers the phone according to established call center metrics.
• Knowledge of assessment process and how to use referral lookup to find results based on consumers need.
• Coordinates appointments and relays authorization information to scheduling staff of location of service, as requested.
• Schedules patients accurately in a timely and polite manner to ensure customer satisfaction.
• Completes HCPC and SUPR coding.
• Provides appropriate and timely documentation in the patient's EMR using standardized workflows and processes.
• Builds and maintains positive working relationships with all contacts
• Acts as a liaison between Unity Place and all referral sources

• Obtains insurance pre-certifications and prior authorizations for scheduled services including assessment, testing for patients.
• Coordinates pre-certs and authorization processes with scheduling staff so appointments can be made in timely manner.
• Obtains any and all pertinent clinic health information from provider, clinical staff and/or EMR to process authorizations, referrals, and pre-certifications.
• Verifies demographic information, including insurance, when scheduling and/or obtaining pre-certifications.
• Monitors outstanding authorization requests and initiates follow-up of outstanding authorizations in a timely manner.
• Maintains current knowledge of payer specific requirements of prior authorizations by attending virtual workshops, researching, and reading newsletters.

• Notifies patient of appointment details via telephone, MyChart, and letter.
• Active listening and evidenced based practices (motivational interviewing, community reinforcement approach, and skills training)
• Ensures patients are scheduled in first available appropriate appointment and location.
• Reinforces instructions to patient per protocol.
• Utilizes exemplary customer service skills with every patient interaction
• Suicide assessment: can demonstrate appropriate utilization of Suicide Assessment scale and make appropriate emergency referral.
• Ability to gather information to gain understanding of individual's current situation and history to make an appropriate judgment on treatment location and patient's readiness for treatment.
• Independently handles communication in a manner that decreases conflict and demonstrates courteous, respectful and caring behavior with sensitivity towards consumers.

Find it here.

Discover the job, the career, the purpose you were meant for. The supportive and inclusive team where you can thrive. The place where growth meets balance - and opportunities meet flexibility. Find it all at Carle Health.

Based in Urbana, IL, Carle Health is a healthcare system with nearly 16,600 team members in its eight hospitals, physician groups and a variety of healthcare businesses. Carle BroMenn Medical Center, Carle Foundation Hospital, Carle Health Methodist Hospital, Carle Health Proctor Hospital, Carle Health Pekin Hospital, and Carle Hoopeston Regional Health Center hold Magnet designations, the nation's highest honor for nursing care. The system includes Methodist College and Carle Illinois College of Medicine, the world's first engineering-based medical school, and Health Alliance. We offer opportunities in several communities throughout central Illinois with potential for growth and life-long careers at Carle Health.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. | For more information: human.resources@carle.com.