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Access Representative I- Utilization Review in San Diego, CA at Scripps Health Plan Services -4S Ranch

Date Posted: 3/28/2019

Job Snapshot

Job Description

At Scripps Health, you will experience the pride, support, respect that has been repeatedly recognized as one of the nation’s Top 100 Places to Work.
You’ll be surrounded by people committed to making a difference in the lives of their patients and their teammates. So if you’re open to change, go ahead and unlock your potential.
You can play a vital part in this role ensuring proper authorizations and referrals for care. This will be at our business services offices near Rancho Bernardo with plenty of amenities on the premises, and close to shopping and housing in the north county area. The ideal candidate will have the ability to work independently and be detail oriented with the ability to enter information accurately on paper and into electronic systems.
The Access Representative is responsible for entering hard copy referrals into IDX and working assigned queues including verification of benefit coverage and eligibility. Responsible for generating managed care approval, pend, denial, and last covered day letters. Assist supervisor with system rule bank rule bank testing and provider dictionary verification

Job Requirements

Required Education/Experience/Specialized Skills:
  • Minimum of 1 year experience in a managed care setting preferably in utilization review.
  • Minimum of 6 months experience with the IDX system preferred.
  • Working knowledge of Word.
  • Moderate level of independence and problem solving skills.
  • High School Diploma.

Preferred Education/Experience/Specialized Skills/Certification:
  • Experience with IPA/Medical Groups and knowledge of referrals and authorizations.
  • Proficient in Microsoft word, Excel and outlook.
  • Knowledge of electronic health records, specifically, Epic.
  • Maintain appropriate documentation on referrals.
  • Good working knowledge of personal computer applications and have the ability to type at a moderate speed.
Scripps Health is repeatedly named on the Fortune Magazine’s 100 Best Companies to work for, the only San Diego-based company and Becker’s Healthcare Top Hospitals. Scripps Health offers a robust Total Rewards Program designed to compensate and motivate you throughout your career. Scripps Health Total Rewards Program includes a broad range of plans and programs including market competitive pay and performance incentives, health and wellness benefits, financial wellness benefits, work-life resources, learning and development opportunities, and rewards and recognition. Unlock your potential with Scripps Health today.
Scripps Health is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex (including pregnancy, sexual orientation, or gender identity/expression), age, marital status, status as a protected veteran, among other things, or status as a qualified individual with disability.