Supervisor, Utilization Management – Authorizations - 26-107

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

Job summary

Hill Physicians Medical Group is seeking a qualified healthcare professional to coordinate the authorization process for our HRM department. The role emphasizes accurate data entry into Epic and adherence to policy provisions.

The ideal candidate has Medical Assistant certification or 1-3 years of healthcare experience, solid knowledge of CPT/ICD10 & HCPCS codes, and proficient MS Office skills. Epic/Tapestry experience is a plus, and teamwork is essential.

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.
• Microsoft Office skills (intermediate).
• Epic/Tapestry experience is a plus.
• 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.

Responsibilities

• Coordinate the authorization process.
• Complete authorization requests per HRM procedures.
• Enter authorization data into Epic database.
• Answer phone queue calls.
• Monitor CSR activity.
• Serve as resource for customer service.
• Maintain open lines of communication across departments.

Skills

Medical terminology

Verbal communication

Attention to detail

Multi-tasking

Team player

Education

H.S. Diploma or GED

Tools

Epic/Tapestry

CPT/ICD10 & HCPCS codes

Microsoft Office

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 ResponsibilitiesComplete 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 ResponsibilitiesServe as resource for customer service.Maintain open lines of communication within all departments of the organization.Required ExperienceMedical Assistant certification and/or 1-3 years of Healthcare experience preferredStrong knowledge of medical terminologyWorking knowledge of CPT/ICD10 & HCPCS codesAccurate data entry and Microsoft Office skills (intermediate).Strong verbal communication, decision-making and problem solving skillsStrong organizational skills and detail orientedAbility to work independently and as part of a teamAble to multi-task and work in a productivity-based environmentEpic/Tapestry experience is a plusRequired EducationH.S. Diploma or GEDAdditional InformationSalary: $108,000 - $138,000 AnnualHill Physicians is an Equal Opportunity Employer