Referral Specialist - Patient Access and Revenue Cycle Admin - Part Time - 8 Hour - Days

Job Description: 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. Work Shift: 08.0 - 08:00 - 17:00 No Waive (United States of America) Pay Range: $27.03 - $36.50 Hourly Offer amounts are based on demonstrated/relevant experience and/or licensure. Pay will be adjusted to the local market if hired outside of the Bay Area. Note: Positions at JMH which are exempt (not eligible for overtime) under the level of Manager are listed as hourly for compensation purposes on this posting. The work shift will contain the word ‘exempt’ on it. Scheduled Weekly Hours: 32 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 and 6,300 employees, The health system’s facilities include John Muir Health, Walnut Creek Medical Center (554-bed acute care facility), which serves as Contra Costa County's only designated trauma center, and John Muir Health, Concord Medical Center (247-bed acute care facility). Together, they are recognized as top centers for neurosciences, orthopedic, cancer, cardiovascular, trauma, emergency, pediatric, and high-risk obstetrics care. Other areas of specialty include general surgery, robotic surgery, weight-loss surgery, rehabilitation and critical care. In February 2024, John Muir Health opened the Behring Pavilion, which is home to the UCSF-John Muir Health Jean and Ken Hofmann Cancer Center in Walnut Creek. This state-of-the-art facility brings cancer prevention, diagnosis, treatment, and care coordination into one location. Patients benefit from the expertise of top cancer specialists from John Muir Health and UCSF Health and have access to the latest treatment advances close to home. John Muir Health also offers complete inpatient and outpatient behavioral health programs and services at our 73-bed fully accredited psychiatric hospital and outpatient center located in Concord. In addition, John Muir Health provides a number of primary care and outpatient services at 89 practice sites throughout the community and urgent care centers in Berkeley, Brentwood, Concord, San Ramon and Walnut Creek. John Muir Health offers a collaborative, patient-centered health care environment with an emphasis on listening, explaining, and working together as a team, to help patients achieve their optimal health. We recognize those who exemplify excellence and reward them for contributing to our collective success. From individual to department to spontaneous recognition, Employee of the Month, Employee Suggestion Program rewards, Employee Success Sharing Program, and many more, we find unique ways to thank our employees for the outstanding efforts they make every day. Competitive salary and benefit package available. Employee of the Month, Employee Suggestion Program rewards, Employee Success Sharing Program, and many more, we find unique ways to thank our employees for the outstanding efforts they make every day. At John Muir Health, we strive to be a leading health system through the cultivation of a culture of belonging where every patient, employee, provider, and community member feels safe and valued for embracing all aspects of their differences. As an Equal Opportunity employer, we encourage and consider all applicants for employment without regard to race, religion, national origin, gender, sexual orientation, gender identity, gender expression, age, veteran status, disability, or any other characteristic protected by law. For more information, please visit the EEO website here. All hospitals are accredited by The Joint Commission, a national surveyor of quality patient care. John Muir Health is an equal opportunity employer. #J-18808-Ljbffr John Muir Health