Supervisor, Utilization Management – Authorizations - 26-107
Sign up free to see how well your resume matches this role.
What you'll do
- 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.
What they're looking for
- H.S. Diploma or GED
- 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
Nice to have
- Medical Assistant certification
- 1-3 years of Healthcare experience
- Epic/Tapestry experience
Summarised by NextRaise from the employer’s description, which follows in full below.
Full description from employer
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
Company
Company facts come from this company's own listings. We only show what the postings themselves carry.