Referral Specialist - PN Patient Access and Revenue Cycle Admin - Per Diem - 8 Hour - Days

About the role

Performs daily operational functions to effectively process authorization requests for full risk and shared risk group plans. Forwards and tracks requests to Utilization Review (UR) and processes determination upon return. Conducts research and communication with providers for retrospective or non-communicated authorizations when no authorization is on file or services are not properly authorized at the time of claim receipt. Assists providers and patients with process and status questions upon request from provider and member services departments. Maintains statistics and reports on authorization activity.

Responsibilities

• Process daily authorization requests for full risk and shared risk group plans
• Forward and track requests to Utilization Review (UR) and process determinations
• Research and communicate with providers for retrospective or non-communicated authorizations
• Assist providers and patients with process and status questions
• Maintain statistics and reports on authorization activity

Requirements

• High School Graduate or Equivalent (preferred)
• Experience with Health Maintenance Organization referrals
• Epic proficiency must be passed within 90 days of start date

Skills

• Knowledge of organizational policies, procedures, systems, and objectives
• Knowledge of medical terminology, ICD-10, CPT, and HCPCS coding
• Trained in Health Insurance Portability and Accountability Act (HIPAA) protocols and security policies
• Proficient in Microsoft Office Products (Word, Excel, Outlook, PowerPoint)
• Ability to maintain professional and personal integrity
• Ability to develop and maintain effective working relationships
• Ability to handle stressful situations diplomatically
• Basic knowledge of medical terminology, anatomy, and physiology
• Skill in developing comprehensive reports

Pay

Hourly pay range: $27.03 - $36.50. Offer amounts are based on demonstrated/relevant experience and/or licensure. Pay will be adjusted to the local market if hired outside of the Bay Area.

Schedule

Per Diem, 08:00 shift (exempt). Scheduled weekly hours: 0.