Job Description

We are so glad you are interested in joining Sutter Health!

Organization:

PAMF-Palo Alto Medical Foundation CADAccountable for ensuring accurate and timely completion of all referrals and authorizations and acts as a resource to providers, clinical operations, and staff. Maintains department metrics and ensures that established turnaround times are adhered to. Works daily to evaluate referral volume, patient call volumes and distributes workload accordingly. Responsible for creating and maintaining workflows and documentation for the following: verifying patient eligibility, coordination of benefits, ensuring accurate insurance coverage, and determining if prior authorization is needed for physician orders. Investigates and responds to patient and provider escalations regarding inquiries and referrals not meeting turnaround standards.

EDUCATION:
Equivalent experience will be accepted in lieu of the required degree or diploma.

Bachelor's: Business, Finance, Computer Science or related field

TYPICAL EXPERIENCE:

• 8 years recent relevant experience
• Pharmacy experience strongly preferred

SKILLS AND KNOWLEDGE:

• Knowledge of insurances and authorization processes.
• Familiarity with government billing regulations, including The Health Care Finance Administration (HCFA), Medicare, and Medi-Cal/Medicaid.
• Medical Terminology, familiarity of state and federal laws regarding Health Insurance Portability and Accountability Act (HIPAA).
• Knowledge of Microsoft Office Suite, including but not limited to Excel, Word and Power Point proficiency.
• Ability to effectively utilize consultative skills and maintain interpersonal relationships with the department and at all levels of the organization.
• Well-developed phone and customer service skills including the ability to professionally, calmly, and effectively work with all customers, including the ability to de-escalate patient and/or provider escalations.
• Organizational and time management skills, with the ability to prioritize multiple projects while delivering quality service and achieving business results.
• Medical terminology, Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS)/International Classification of Diseases (ICD)-9 coding knowledge.
  

Job Shift:

Days

Schedule:

Full Time

Days of the Week:

Monday - Friday

Weekend Requirements:

As Needed

Benefits:

Yes

Unions:

No

Position Status:

Exempt

Weekly Hours:

40

Employee Status:

Regular

Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.

Pay Range is $107,785.60 to $161,678.40 / annual salary

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.