Referral Specialist - Pn Primary Care Clinic - Berkeley - Full Time - 8 Hour - Days

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.

• High School Graduate or Equivalent Preferred

• Health Maintenance Organization Referrals Required

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

• Must be able to maintain effective working relationships with a wide variety of individuals.
• Skill in developing comprehensive reports.
• Basic knowledge of medical terminology, anatomy and physiology.
• Knowledge of organizations policies, procedures, systems and objectives.
• Ability to deal diplomatically with all types of individuals under stressful situations.
• Maintains professional and personal integrity.
• Proficient in Microsoft Office Products (Word, Excel, Outlook and Power Point).
• 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.

08.0 - 08:00 - 17:00 No Waive (United States of America) $24.99 - $33.74 Hourly 40