We are so glad you are interested in joining Sutter Health!

Organization

SPMF-Sutter Pacific Medical Foundation - South

Position Overview

Responsible for performing the appropriate processes to verify patient eligibility, coordinate benefits, ensure insurance coverage, and determine if prior authorization is needed for said order. If needed, obtains authorization and documents in the patient electronic medical record. Facilitates responses to patient inquiries regarding authorizations within turnaround standards.

Job Description

• Verifies patient eligibility, facility approval, follows up as necessary to obtain authorization in a timely fashion and enters authorization numbers in medical record/computer as directed.
• Collects pertinent demographics and clinical data for each authorization required and places calls to insurance companies and/or reviews organizations to obtain authorization.
• Enters all authorization requests into the patient’s electronic health record utilizing appropriate codes, treatment types and providers.
• Communicates with physicians and department staff when there are issues with authorization.
• Interfaces with patients or third-party payers as necessary to gather additional information and convey approvals, denials or appeals.
• Provides excellent customer service by listening to provider, staff and patient concerns and assisting them in resolving issues in a courteous manner while documenting appropriately.
• Cross-trains others to assure consistent coverage; provide back up support as needed.
  
  

Education

HS Diploma or GED

Typical Experience

1 year recent relevant experience.

Skills And Knowledge

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 judgments, 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.

Job Shift

Days

Schedule

Full Time

Shift Hours

8

Days Of The Week

Monday - Friday

Weekend Requirements

None

Benefits

Yes

Unions

No

Position Status

Non-Exempt

Weekly Hours

40

Employee Status

Regular

Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.

Pay Range is $31.88 to $39.83 / hour

The salary range for this role may vary above or below the posted range as determined by location. This range has not been adjusted for any specific geographic differential applicable by area where the position may be filled. Compensation takes into account several factors including but not limited to a candidate’s experience, education, skills, licensure and certifications, department equity, training and organizational needs. Base pay is just one piece of the total rewards program offered by Sutter Health. Eligible roles also qualify for a comprehensive benefits package.