Supervisor, Utilization Management – Authorizations - 26-107

PriMed Management Consulting Services, Inc.; Sacramento (CA); On-site; USD 108,000 - 138,000; Full time

Job summary

Hill Physicians Medical Group is seeking a Detail-Oriented Authorization Support Specialist to coordinate the authorization process and support the Health Resources Management Department (HRM) in Sacramento. You will review requests, apply benefits criteria, and ensure timely decisions.

This role requires medical terminology knowledge, CPT/ICD-10 & HCPCS familiarity, accurate data entry into Epic, and strong communication with members and providers.

Qualifications

• 1–3 years of healthcare experience preferred.
• Medical terminology knowledge required.
• Familiar with CPT/ICD-10 & HCPCS codes.
• Accurate data entry with intermediate Microsoft Office.
• Strong verbal communication and problem solving.
• Organizational skills and detail oriented.
• Ability to work independently and as part of a team.
• Ability to multitask in a productivity-based environment.

Responsibilities

• Complete authorization requests per HRM procedures.
• Research and troubleshoot complex rules to render correct decisions.
• Enter authorization data into Epic using correct types and codes.
• Answer phone queue in accordance with departmental standards.
• Monitor CSR activity and respond within standards.
• Serve as a resource for customer service.
• Maintain open communication across departments.

Skills

Medical terminology

Data entry

Microsoft Office

Verbal communication

Organizational skills

Teamwork

Multi-tasking

Independent work

Education

High School Diploma or GED

Tools

Epic/Tapestry

Job description

At Hill Physicians Medical Group, we’re shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members.

DE&I Statement

At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are. We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities.

Job Description

Coordinate the authorization process and support the Health Resources Management Department (HRM).

Job Responsibilities

• Complete authorization requests in accordance to the operational procedures outlined within the HRM Operations Manual and Policy Provisions.
• Researching and troubleshooting complex authorization rules to render the correct decision based on members’ benefits, a Health Plans’ contractual arrangements, and specific criteria to determine if service may be authorized.
• Enter authorization data into Epic database using correct types and codes.
• Answer phone queue line calls in accordance with departmental standards.
• Monitor Customer Service Requests (CSR) activity; respond appropriately within department standards.
• Serve as resource for customer service.
• Maintain open lines of communication within all departments of the organization.

Required Experience

• 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
• Able to multi-task and work in a productivity-based environment
• Epic/Tapestry experience is a plus

Required Education

• H.S. Diploma or GED

Additional Information

Salary: $108,000 - $138,000 Annual Hill Physicians is an Equal Opportunity Employer PriMed Management Consulting Services, Inc., is the management services organization for Hill Physicians Medical Group, the largest Independent Physician Association (IPA) in Northern California. More than just a job - We’re making a meaningful contribution to healthcare. Everyone at PriMed contributes to making quality healthcare accessible for Northern Californians. We have a unique collection of skilled professionals that work well together and have been recognized as one of the top places to work and one of the healthiest places to work in the Bay area.