About the role
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 - $36.50HourlyNote: 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:
40Aplyr's read
John Muir Health is a leading healthcare provider in the San Francisco Bay Area, known for its comprehensive services and commitment to patient care.
What's promising
- •John Muir Health offers a wide range of specialized medical services, enhancing career growth opportunities.
- •Located in the dynamic San Francisco Bay Area, it attracts diverse healthcare professionals.
- •Strong emphasis on psychiatric and cardiovascular care, providing focused career paths.
What to watch
- •High demand for psychiatric services may indicate stressful work environments.
- •Limited public information about employee satisfaction and organizational culture.
- •Potential challenges with work-life balance due to variable shifts and per diem roles.
Why John Muir Health
- •John Muir Health integrates outpatient and inpatient services, offering diverse patient care experiences.
- •Focus on psychiatric and chemical dependency services sets it apart in the region.
- •Comprehensive cardiac care services provide unique opportunities for specialized nursing roles.
Aplyr’s read is generated by AI from public sources. Was it useful?
About John Muir Health
John Muir Health is a comprehensive healthcare system providing a wide range of medical services, including hospitals, outpatient facilities, and physician practices in the San Francisco Bay Area.
