Organization:
SPMF-Sutter Pacific Medical Foundation - South

Position Overview:
Provides medical administration support to providers by obtaining referral or prior authorizations for patients to see specialty providers. Completes referrals and/or authorizations accurately and consistently with minimal supervision. In Managed Care, processes authorization and referral requests for members in coordination with health plans and contracted providers. Provides support to the Case Management staff. Serves as a resource to providers regarding the authorization process.

Job Description:

These Principal Accountabilities, Requirements and Qualifications are not exhaustive, but are merely the most descriptive of the current job. Management reserves the right to revise the job description or require that other tasks be performed when the circumstances of the job change (for example, emergencies, staff changes, workload, or technical development).

JOB ACCOUNTABILITIES:

• Completes referrals and/or authorizations accurately and consistently with minimal supervision.
• Plans and manages own routine assignments.
• Demonstrates understanding of the dynamic environment of insurance companies and their demands in order to facilitate approval.
• Prioritizes multiple requests, responds quickly and appropriately to shifting priorities.
• Refers all out of network referrals to contracting department for fee negotiation.
• Receives and coordinates all requests for referrals and/or authorizations from HMO, PPO, Medicare, and/or Partnership.
• Communicates with providers to gather information/documentation needed for processing referrals.
• Serves as a resource to medical management staff regarding issues related to the authorization process.
• Assists physician offices in coordinating complex specialist appointments with external specialists.
• Verifies that the appropriate medical information has been received and forwarded to all outside medical group specialists.

EDUCATION:

HS Diploma or GED

DEPARTMENT REQUIRED CERTIFICATIONS & LICENSURES

Department, Home Health: AUTO-Automobile Insurance (remote employees excluded)

Department, Home Health: DL-Valid Drivers License (remote employees excluded)

TYPICAL EXPERIENCE:

2 years recent relevant experience.

SKILLS AND KNOWLEDGE:

Medical terminology, Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS)/International Classification of Diseases (ICD)-9 coding knowledge.

Knowledge of medical terminology/anatomy.

Ability to exercise discretion and make independent judgements, seeking review when decisions represent significant departure from established guidelines.

Knowledge of Microsoft Office programs including Excel, Word or similar programs.

Ability to maintain composure during challenging interpersonal interactions.

Active listening skills; including interpersonal skills and telephone communication.

Organizational skills with attention to detail and follow-up.

PHYSICAL ACTIVITIES AND REQUIREMENTS:

See required physical demands, mental components, visual activities & working conditions at the following link: Job Requirements

Job Shift:
Days

Schedule:
Full Time

Shift Hours:
8

Days of the Week:
Monday - Friday

Weekend Requirements:
None

Benefits:
Yes

Unions:
No

Position Status:
Non-Exempt

Weekly Hours:
40

Employee Status:
Regular

Pay Range is $33.45 to $46.83 / hour

The compensation range may vary based on the geographic location where the position is filled. Total compensation considers multiple factors, including, but not limited to a candidate's experience, education, skills, licensure, certifications, departmental equity, training, and organizational needs. Base pay is only one component of Sutter Health's comprehensive total rewards program. Eligible positions also include a comprehensive benefits package.