Overview
The Carle Link Access Specialist is responsible for the coordination, processing, and scheduling of medical referrals and prior authorizations for a variety of medical or diagnostic procedures for patients. This role facilitates communication between Carle Physician Group providers, external facilities and Health Alliance members when external referrals are ordered in Epic. The Carle Link team provides one centralized service for outbound ambulatory referrals of Health Alliance patients and centralized source of referral data for the enterprise. The goal of this position is to reduce unnecessary referrals out of the Carle Health system and ensure external referrals of Health Alliance patients stay in-network for their specific insurance plans.
Qualifications
Certifications: , Education: , Work Experience: Related field
Responsibilities
Develops and maintains knowledge base of current Carle provider specialists and the breadth and depth of Carle specialty services. Demonstrates a deep understanding and respect for patient communities, providers, quaternary healthcare providers and Health Alliance.
Provides excellent service to all customers, providers, and patients regardless of the complexity of the situations presented. Advocates for patients in their navigation of the Carle system and outside clinics when Carle cannot provide the services needed.
Collaborates with Health Alliance and other health insurance plans, ambulatory nursing and leadership, external providers, internal providers, IT-EMR, Business Development, Regional Outreach Physician Liaisons, Social Work, Radiology, and Health Information Management.
Prevents unnecessary visits/claims for repeat diagnostics and/or misdirected referrals.
Reviews and submits information required to complete pre-authorizations with insurance companies. Refers members to Health Alliance's Care Coordination team when on-going needs are evident.
Contacts various clinics, facilities, companies to obtain information to accurately complete referral/pre authorization requests.
Utilizes third party payer/insurance portals; has a detailed knowledge of insurance providers, their portals and their expectations for authorization approval.
Communicates all appeals to patient and referring provider and assists, as needed, in compiling data and documenting the sequence of events thoroughly. Assist patient with finding in-network specialist.
Coordinates transmission of information back to Carle when patients are sent out of system for referrals.
Participates in new provider orientations, service line department meetings and travel to outreach locations as needed.
About Us
**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:
[email protected]._
Compensation and Benefits
The compensation range for this position is $16.45per hour - $26.65per hour. This represents a good faith minimum and maximum range for the role at the time of posting by Carle Health. The actual compensation offered a candidate will be dependent on a variety of factors including, but not limited to, the candidate's experience, qualifications, location, training, licenses, shifts worked and compensation model.
Carle Health offers a comprehensive benefits package for team members and providers. To learn more visit careers.carlehealth.org/benefits.