Transfer & Referral Specialist II
Required skills
- Managed care requirements
- insurance authorization
- HIPAA
- medical terminology
- managed care terminology
- disease process
- confidential clinical information
- specialty services
- referrals
- transfers
Nice to have
- Bachelor's in Business
Role summary
Sutter Health is seeking a Transfer & Referral Specialist II for their SMCS-Valley Administration team. This role involves reviewing confidential clinical information, providing personalized referrals to specialty services, and facilitating transfers to appropriate Sutter facilities or affiliated specialists. The position requires working knowledge of managed care requirements, insurance authorization processes, HIPAA, and medical terminologies. The specialist will also assess referral requests based on disease processes and utilize data analysis and communication skills to manage activities and maintain confidentiality. This is a full-time, limited-term, non-exempt position requiring every other weekend availability.
We are so glad you are interested in joining Sutter Health!
Organization:
SMCS-Valley AdministrationPosition 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 transfers to appropriate Sutter facility, program or affiliated and aligned specialists.Job Description:
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.
- Displays a customer service focus in all decisions and actions.
- Ability to communicate through verbal and written means, and to present information to a variety of audiences..
- Organization skills to effectively manage and/or re-prioritize activities and projects to meet deadlines while maintaining a high degree of responsiveness.
- Ability to interact and maintain effective working relationships with those contacted in the performance of required duties.
- Demonstrates respect for cultural and linguistic differences and promotes an inclusive work environment.
- Demonstrates initiative in providing feedback/input to improve workflow/processes.
- Ability to work effectively in a dynamic and fast-paced environment with changing business priorities.
- Ability to maintain and work discreetly with confidential and sensitive information.
- Ability to use essential applications and/or databases associated with the role’s duties and responsibilities.
Job Shift:
NightsSchedule:
Full TimeShift Hours:
8Days of the Week:
VariableWeekend Requirements:
Every other WeekendBenefits:
YesUnions:
NoPosition Status:
Non-ExemptWeekly Hours:
32Employee Status:
Limited Term (Fixed Term)Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.
Pay Range is $28.00 to $52.56 / hourThe posted pay range is based on the position's primary work location. Candidates who reside and work outside of that location may be subject to a different pay range based on their work location. Candidate starting salaries consider multiple factors, including, but not limited to a candidate’s experience, education, skills, licensure, certifications, departmental equity, training, and organizational needs. Base pay is only one component of Sutter Health’s comprehensive total rewards program. Eligible positions also include a comprehensive benefits package.
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