Referral Processor II
Primary Location Aurora, Colorado
Worker Location Remote
Job Number 1323009 Date posted 11/19/2024
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Description:
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 ones actions; accurate department processes to ensure quality processing. Considers how timely and accurate referral processing will affect members.
Job Summary:
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 ones 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 members 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.
Notes:
- Includes weekends and holidays- required - MUST LIVE IN COLORADO
Primary Location: Colorado,Aurora,Waterpark I
Scheduled Weekly Hours: 1
Shift: Day
Workdays: Mon, Tue, Wed, Thu, Fri, Sat, Sun
Working Hours Start: 12:00 AM
Working Hours End: 11:59 PM
Job Schedule: Call-in/On-Call
Job Type: Standard
Worker Location: Remote
Employee Status: Regular
Employee Group/Union Affiliation: C01|SEIU|Local 105
Job Level: Individual Contributor
Department: Waterpark I - Med Ofc Admin-Ac Teams - 1608
Pay Range: $28.35 - $38.62 / hour
The ranges posted above reflect the location in the job posting. The salary range may vary if you reside in a different location or state than the location posted.
Travel: No
Remote: Work location is the remote workplace (from home) within KP authorized states.
Worker location must align with Kaiser Permanente's Authorized States policy.
At Kaiser Permanente, equity, inclusion and diversity are inextricably linked to our mission, and we aim to make it a part of everything we do. We know that having a diverse and inclusive workforce makes Kaiser Permanente a better place to receive health care, a more supportive partner in our communities we serve, and a more fulfilling place to work. Working at Kaiser Permanente means that you agree to and abide by our commitment to equity and our expectation that we all work together to create an inclusive work environment focused on a sense of belonging and wellbeing.
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. Submit Interest
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. Submit Interest
