Transfer & Referral Specialist II

Job description

We are so glad you are interested in joining Sutter Health! Organization: SHSO-Sutter Health System Office-Valley Position Overview: Reviews confidential clinical information and provides personalized referrals to individuals or physicians/clinics requiring specialty services from a contracted medical group, hospital, or third-party payor. Facilitates referrals to appropriate Sutter facility, program or affiliated and aligned specialists. EDUCATION: Equivalent experience will be accepted in lieu of the required degree or diploma. Bachelor's in Business and/or Healthcare Administration, or related field. TYPICAL EXPERIENCE: 2 years of recent relevant experience. SKILLS AND KNOWLEDGE: Working knowledge of managed care requirements and processes. Knowledge of system, affiliate and community resources, and third-party payers (e.g., PPO, HMO, Medicare, insurance plans). knowledge of insurance authorization process and HIPPA requirements. Familiar with medical and managed care terminologies. Understanding of disease process to assess referral requests and appropriate level/provider of care required. Ability to define issues, collect data, establish facts and draw valid conclusions. Displ...