Clinical Liaison III

Sutter Health•Roseville, CA

22h•Onsite

About The Position

Handles the day-to-day review, coordination and management of referral/authorization requests for services requiring clinical background and understanding from a provider operational and payer requirement perspective. Serves as a functional liaison to Financial Clearance Representatives (pre-service), Patient Access Representatives (point of service), insurance companies, physicians and hospital Administration. Enhances the patient experience throughout all interactions demonstrating knowledge of Sutter's Health system and service offerings. Facilitates Medicare National Coverage Determination (NCD) and Local Coverage Determination (LCD) process on behalf of Sutter Health hospitals to ensure physician and hospital compliance with conditions of coverage prescribed within Medicare National Coverage Determination.

Requirements

Graduate of an accredited school of nursing.
RN-Registered Nurse of California.
2 years recent relevant experience.
Insurance payer knowledge and background.
Working knowledge of medical and insurance terminology.
Understanding of healthcare insurance.
Ability to carry out defined procedures and policies under specific instruction.
Assertive, organized, self-directed and able to prioritize work assignments, perform multiple tasks concurrently.
Ability to utilize multiple modes of communication (e.g. phone, fax, patient portal, e-mail, physician portal, mail, etc.) in a professional, accurate, efficient and courteous manner.
Computer proficiency skills.
Data entry skills.
Verbal and written communication and active listening skills.
Interpersonal skills necessary in dealing with internal and external customers.
Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Sutter Health.
Accuracy and attentiveness to detail.
Must be able to set and organize own work priorities, and adapt to change.
Ability to meet or exceed targeted customer service, productivity and quality standards.
Requires the ability to work with and maintain confidential information.

Responsibilities

Review, coordinate, and manage referral/authorization requests for services.
Act as a liaison to Financial Clearance Representatives, Patient Access Representatives, insurance companies, physicians, and hospital Administration.
Enhance the patient experience.
Facilitate the Medicare National Coverage Determination (NCD) and Local Coverage Determination (LCD) process.