Referral Processor II

Performs a variety of procedures to process complex outside medical referrals, functions as a liaison, and works independently. Ensures timely accurate processing resulting in making members/patients and their needs a primary focus of one's actions; accurate department processes to ensure quality processing. Considers how timely and accurate referral processing will affect members.
Essential Functions:
Processes complex outside medical referrals; reviews referral for completeness and requests additional information as necessary; verifies member eligibility, ensures appropriate review nurse approval is obtained when necessary (codes diagnoses and procedures) and enters information into system.
Maintains relationships with vendors, physicians and members with regard to questions and problems with referrals, including keeping outside providers updated with pertinent information to process referrals (Researches each referral to ensure service requested is a benefit for the member. Gathers data on interregional members and verifies eligibility status by contacting member's home region.). Performs other duties as assigned by management.
Basic Qualifications:
Four (4) years of previous experience in a healthcare industry.
Minimum of six (6) months experience authorizing/denying referral requests.
High school graduation or equivalent.
License, Certification, Registration
Additional Requirements:
Demonstrated ability to read/interpret provider orders and to apply medical coding procedures using CPT-4 and ICD-9.
Demonstrated customer service skills, customer focus abilities and the ability to understand Kaiser Permanente customer needs.
Typing speed of 35 w.p.m.
10 key by touch.
Preferred Qualifications:
Medical terminology preferred.

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