Job Description

Referral Processor II - DEPARTMENT ONLY

Location: Aurora, CO Job Number: 975248 Date posted: 08/07/2021 Submit Interest Add to Favorites Remove from Favorites

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Description:
SEIU Local 105 - $24.21 - $27.55
“May be entitled to translation/bilingual, shift or other wage premiums as governed by the applicable collective bargaining agreement. Please refer to the respective collective bargaining agreement for additional information on such wage premiums: https://www.lmpartnership.org/local-contracts."
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 Responsibilities:

• This position, knows and complies with all Kaiser Permanente quality, safety, and emergency policies and procedures. Demonstrates quality and effectiveness in work habits and clinical practice in every interaction with patients, colleagues, providers, and leadership. Ensures patient safety in the preparation and provisioning of care related to but not limited to medications, procedures, infection prevention, fall prevention, including consistent use of two patient identifiers and procedural time outs. Reports safety hazards, accidents and incidents, and unsafe working conditions promptly.


• 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: Experience

Four (4) years of previous experience in a healthcare industry.

Minimum of six (6) months experience authorizing/denying referral requests.

Education

High school graduation or equivalent.

License, Certification, Registration

N/A

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.

Primary Location: Colorado,Aurora,Waterpark III Scheduled Weekly Hours: 40 Shift: Day Workdays: Sun, Mon, Tue, Wed, Thu, Fri, Sat Working Hours Start: 12:00 AM Working Hours End: 11:59 PM Job Schedule: Full-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: C01|SEIU|Local 105 Job Level: Individual Contributor Department: Waterpark III - Rgnl Quality Resource Mgmt - 1608 Travel: No Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.
External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.
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