Patient Services Representative II

Sutter Health•San Francisco, CA

22h•$32 - $45•Onsite

About The Position

Provides medical administration support to providers by obtaining referral or prior authorizations for patients to see specialty providers. Completes referrals and/or authorizations accurately and consistently with minimal supervision. In Managed Care, processes authorization and referral requests for members in coordination with health plans and contracted providers. Provides support to the Case Management staff. Serves as a resource to providers regarding the authorization process.

Requirements

HS Diploma or GED
2 years recent relevant experience.
Medical terminology, Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS)/International Classification of Diseases (ICD)-9 coding knowledge.
Knowledge of medical terminology/anatomy.
Ability to exercise discretion and make independent judgements, seeking review when decisions represent significant departure from established guidelines.
Knowledge of Microsoft Office programs including Excel, Word or similar programs.
Ability to maintain composure during challenging interpersonal interactions.
Active listening skills; including interpersonal skills and telephone communication.
Organizational skills with attention to detail and follow-up.

Nice To Haves

AUTO-Automobile Insurance (remote employees excluded)
DL-Valid Drivers License (remote employees excluded)

Responsibilities

Completes referrals and/or authorizations accurately and consistently with minimal supervision.
Plans and manages own routine assignments.
Demonstrates understanding of the dynamic environment of insurance companies and their demands in order to facilitate approval.
Prioritizes multiple requests, responds quickly and appropriately to shifting priorities.
Refers all out of network referrals to contracting department for fee negotiation.
Receives and coordinates all requests for referrals and/or authorizations from HMO, PPO, Medicare, and/or Partnership.
Communicates with providers to gather information/documentation needed for processing referrals.
Serves as a resource to medical management staff regarding issues related to the authorization process.
Assists physician offices in coordinating complex specialist appointments with external specialists.
Verifies that the appropriate medical information has been received and forwarded to all outside medical group specialists.