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.
08.0 - Per Diem Days No Waive (United States of America)
Pay Range:
$27.03 - $36.50Hourly
0
John Muir Health is a nationally recognized, not-for-profit health care organization east of San Francisco serving patients in Contra Costa, Alameda and southern Solano Counties. It includes a network of more than 1,000 primary care and specialty physicians, more than 6,000 employees, medical centers in Concord and Walnut Creek, including Contra Costa County’s only trauma center, and a Behavioral Health Center. John Muir Health also has partnerships with UCSF Health, Tenet Healthcare/San Ramon Regional Medical Center and Stanford Children's Health. The health system offers a full-range of medical services, including primary care, outpatient and imaging services, and is widely recognized as a leader in many specialties – neurosciences, orthopedic, cancer, cardiovascular, trauma, emergency, pediatrics and high-risk obstetrics care.
John Muir Health is a collaborative, patient-centered health care environment. Listening, explaining and working together as a team, we help patients achieve their optimal health through partnership between physicians, employees and volunteers built on mutual respect, support for each other, and personal accountability. We believe in each other. We empower each other. We celebrate each other¹s successes, and our differences. We recognize those who exemplify excellence, and reward them for contributing to our collective success.
