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 in Sacramento is seeking an Authorization Coordinator to support the Health Resources Management Department. You will coordinate authorization requests, review benefits, and enter data in the Epic system.

The ideal candidate has a Medical Assistant certification or 1–3 years in healthcare, strong knowledge of medical terminology, CPT/ICD10 & HCPCS codes, and solid data-entry and communication skills. Epic/Tapestry experience is a plus.

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

Responsibilities

• Coordinate the authorization process and support the Health Resources Management Department (HRM).
• Research complex authorization rules to determine if services may be approved based on benefits and contracts.
• 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

Communication

Teamwork

Epic/Tapestry

Education

High School Diploma or GED

Tools

Epic/Tapestry

Job description

We’re delighted you’re considering joining us!

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.

Join Our Team!

Hill Physicians has much to offer prospective employees. We’re regularly recognized as one of the “Best Places to Work in the Bay Area” and have been recognized as one of the “Healthiest Places to Work in the Bay Area.” When you join our team, you’re making a great choice for your professional career and your personal satisfaction.

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. We do it because it’s right!

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.
• This includes:
• 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.

Additional Responsibilities

• 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