Referral Specialist - Specialty Suite-Berkeley OPC - Full Time - 8 Hour - Days*

John Muir Health Berkeley , CA 94705

Posted 2 months ago

Job Description:

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.

Education:

  • High School Graduate or Equivalent Preferred

Experience:

  • Health Maintenance Organization Referrals Required

Certifications/Licensures:

  • Epic - Proficiency must be passed within 90 days of Start Date Required

Skills:

  • Knowledge of organizations policies, procedures, systems and objectives.

  • Knowledge of medical terminology, ICD-10, CPT and HCPCS coding required.

  • Trained in Health Insurance Portability and Accountability Act (HIPAA) general protocols with additional training specific to department as required & Security Policies and Procedures.

  • Proficient in Microsoft Office Products (Word, Excel, Outlook and Power Point).

  • Maintains professional and personal integrity.

  • Must be able to maintain effective working relationships with a wide variety of individuals.

  • Ability to deal diplomatically with all types of individuals under stressful situations.

  • Basic knowledge of medical terminology, anatomy and physiology.

  • Skill in developing comprehensive reports.

Work Shift:

08.0 - 08:00 - 17:00 (United States of America)

Scheduled Weekly Hours

40

icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Licensed Vocational NurseAmbulatory Specialty SuiteBerkeley OPC Full Time 8 Hour Days

John Muir Health

Posted 2 months ago

VIEW JOBS 10/9/2020 12:00:00 AM 2021-01-07T00:00 Job Description: The Licensed Vocational Nurse (LVN) works with the providers and other members of the health care team performing a variety of clinical and administrative patient-related duties. The LVN also works to fulfill a variety of patient needs and ensures smooth work flows within the practices. Performs selected patient care and administrative functions as designated by the Provider / Site Manager or Supervisor. Provides backup clinical and administrative support to the Medical Assistants, call center, schedulers and reception. Education: * Completion of Licensed Vocational/Practical Nurse Program Required Experience: * 2 years LVN Required preferably in a Physician office setting Certifications/ Licensure: * LVN Licensed Vocational Nurse - California Board of Vocational Nursing and Psychiatric Technicians Required * BLS Basic Life Support - American Heart Association Required Skills: * Ability to communicate effectively orally and in writing. * Prior EPIC EMR experience preferred. * Knowledge of organizational policies, procedures, systems and objectives. * Ability to deal professionally with all types of individuals under stressful situations. Work Shift: 08.0 - 08:00 - 17:00 (United States of America) Scheduled Weekly Hours 40 John Muir Health Berkeley CA

Referral Specialist - Specialty Suite-Berkeley OPC - Full Time - 8 Hour - Days*

John Muir Health