enters specific data/information from physicians requests into a medical management authorization system, achieving required production quota/quality standards. * Validates patient and medical provider demographic information including correct selection of a medical provider by specialty for healthcare service. * Determines whether patients are eligible to receive health care benefits under the insurance program by determining the patients status/eligibility the Primary Care Manager (doctor) type, and the appropriate referral/authorization path. * Contacts medical provider offices by telephone, and makes confirmation calls to patients for all urgent requests. Uses sound judgment in making decisions in order to keep the referral/authorization process moving forward in accordance with contractual timeliness standards. * Follows step-by-step instructions, including redirecting patients into the provider network for care, as required by contractual standards. * Formulates brief sentences/paragraphs from referral/authorization orders and prepares correspondence in business letter format to provide clinical information to servicing providers. * Generates letters and reviews to validate that they are going to the correct providers/patients, and that the provider/patient demographics and reason(s) for services to be rendered are correct. * Accounts accurately for personal production via a production report that includes outcome data such as closed transactions, duplicative transactions and requests. * Meets goals and produces results through tracking performance, improving work processes, and prioritizing work and tasks. * Achieves successful solutions by reviewing situations and ensuring a full understanding before taking steps to resolve. Key components of this responsibility are objectively identifying problems, recognizing patterns, and determining solutions. * Works as a team member; cooperates, assists and collaborates with co-workers to achieve goals and department success, and takes personal responsibility for achieving outstanding customer service. Education/Experience: High School diploma or equivalent; college course work preferred. Requires minimum six months experience in a production/data entry environment performing alpha and numeric data entry in a healthcare related organization such as managed care, claims/billing, health insurance, customer service, call center, or claims office. Government Security/Clearance/Citizenship Requirements: This position requires US Citizenship and proof of favorable adjudication following submission of Department of Defense form SF86 or higher security License/Certification: Medically based trade school diploma/certification, desired. **Primary Location: **USA-California-Rancho Cordova **Work Locations: ** **Job: **Health Insurance Operations **Organization: **Health Net, Inc. **Schedule: **Full-time