Transfer & Referral Specialist

Sutter Health•Sacramento, CA

12d•Onsite

About The Position

The Transfer & Referral Specialist reviews confidential clinical information and provides personalized referrals to individuals or physicians and clinics requiring specialty services from a contracted medical group, hospital, or third-party payor. The specialist facilitates referrals to an appropriate Sutter facility, program, or affiliated and aligned specialist. This is a fully onsite, part-time position with variable days, an eight-hour day shift, and every-other-weekend requirements.

Requirements

A bachelor's degree in Business, Healthcare Administration, or a related field, or equivalent education or experience. Equivalent experience may be accepted in lieu of the required degree or diploma.
Working knowledge of managed care requirements and processes.
Knowledge of system, affiliate, and community resources and third-party payors, including PPOs, HMOs, Medicare, and insurance plans.
Knowledge of insurance authorization processes and HIPAA requirements.
Familiarity with medical and managed care terminology.
Understanding of disease processes to assess referral requests and appropriate levels and providers of care.
Ability to define issues, collect data, establish facts, and draw valid conclusions.
Customer-service focus in decisions and actions.
Verbal and written communication skills, including the ability to present information to varied audiences.
Organizational skills to manage and reprioritize activities and projects, meet deadlines, and remain responsive.
Ability to interact and maintain effective working relationships with people contacted in the performance of duties.
Respect for cultural and linguistic differences and support for an inclusive work environment.
Ability to work effectively in a dynamic, fast-paced environment with changing business priorities.
Ability to use essential applications and databases associated with the role.

Nice To Haves

Two years of progressively responsible experience in healthcare or medical insurance, Health Information Management, Admitting/Patient Access, Patient Financial Services, and/or Case Management.
Two years of experience in an acute and/or non-acute healthcare setting.
Two years of experience working with computerized systems and/or electronic medical records.

Responsibilities

Review confidential clinical information.
Provide personalized referrals to individuals, physicians, and clinics requiring specialty services.
Facilitate referrals to appropriate Sutter facilities, programs, and affiliated or aligned specialists.
Assess referral requests and determine the appropriate level and provider of care.
Maintain discretion when working with confidential and sensitive information.
Provide feedback and input to improve workflows and processes.