Lead Utilization Management — Complex Care Authorizations

Hill Physicians Medical Group; Sacramento (CA); On-site; USD 108,000 - 138,000; Full time

Job summary

Hill Physicians Medical Group in California is seeking an Authorization Specialist to coordinate the authorization process and support the Health Resources Management Department (HRM). This role ensures accurate decisions based on member benefits, contracts, and policy provisions.

The ideal candidate holds a Medical Assistant certification or 1–3 years healthcare experience, with strong medical terminology, CPT/ICD10/HCPCS knowledge, and solid data entry and MS Office skills.

Qualifications

• Medical Assistant certification and/or 1-3 years of Healthcare experience preferred.
• Strong knowledge of medical terminology.
• Working knowledge of CPT/ICD10 & HCPCS codes.
• Accurate data entry and Microsoft Office skills (intermediate).
• Strong verbal communication, decision-making and problem solving skills.
• Strong organizational skills and detail oriented.
• Ability to work independently and as part of a team.
• Epic/Tapestry experience is a plus.

Responsibilities

• Coordinate the authorization process in accordance with HRM policies.
• Researching and troubleshooting complex authorization rules to render correct decisions.
• Enter authorization data into Epic database using correct types and codes.
• Answer phone queue calls in accordance with departmental standards.
• Monitor CSR activity and respond within department standards.

Skills

Medical terminology

Data entry

Microsoft Office

Verbal communication

Teamwork

Organization

Education

H.S. Diploma or GED

Tools

Epic/Tapestry

Job description

Hill Physicians Medical Group in California is seeking an Authorization Specialist to coordinate the authorization process and support the Health Resources Management Department (HRM). This role ensures accurate decisions based on member benefits, contracts, and policy provisions.

The ideal candidate holds a Medical Assistant certification or 1–3 years healthcare experience, with strong medical terminology, CPT/ICD10/HCPCS knowledge, and solid data entry and MS Office skills.