Authorizations Coordinator I
Not Disclosed•Full-TimeOn-site
location_onRichards Boulevard, Sacramento, Sacramento County, California, 95814, United States
About Hill Physicians Medical Group
At Hill Physicians Medical Group, we are shaping the healthcare of the future through actively managed care that prevents disease, supports those with chronic conditions, and anticipates the needs of our members. We are regularly recognized as one of the "Best Places to Work in the Bay Area" and one of the "Healthiest Places to Work in the Bay Area." Joining our team is a choice that offers both professional growth and personal satisfaction.
About the Role
The Utilization Management Coordinator serves as a vital link within the Health Resources Management (HRM) Department. This role is dedicated to coordinating the authorization process, ensuring that every request is researched, processed, and modified in strict accordance with CMS, DMHC, Health Plan, and Hill Physicians guidelines. You will act as a resource for the broader Utilization Management team, supporting both clinical and non-clinical associates through interactions with providers, facilities, and members. Your work ensures that complex authorization rules are navigated correctly to render decisions based on member benefits and contractual arrangements.
Our Culture & Values
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!
Equal Opportunity Employer
Hill Physicians is an Equal Opportunity Employer.
Work location
Work model: On-site
Richards Boulevard, Sacramento, Sacramento County, California, 95814, United States
Sacramento, California
Key Responsibilities
- check_circleEnter incoming verbal, mail, and eFax requests for service using correct types and codes
- check_circleAnswer phone queue line calls and monitor customer service requests within department standards
- check_circleConduct outreach calls to provider offices and member notification calls for urgent requests
- check_circleProcess all incoming and outgoing correspondence and faxes within timeliness guidelines
- check_circleDocument all notes pertaining to the UM function in the Referral Management System
- check_circlePerform clerical duties including urgent call processing, mailing notifications, and document retrieval
- check_circleResearch and troubleshoot complex authorization rules based on member benefits and contracts
- check_circleComplete authorization intake checklists and requests per operational procedures
- check_circleCreate, update, maintain, and close authorizations or tasks within client process guidelines
- check_circleMaintain current knowledge of Utilization Management processes, timelines, and medical codes
Requirements
- verifiedHigh school diploma or equivalent (GED)
- verifiedAccurate use of medical terminology and codes (ICD-10, HCPC and CPT)
- verifiedKnowledge and expertise in using Outlook email
- verifiedData entry and computer skills
- verifiedAbility to learn and adhere to health plan and regulatory compliance requirements for UM
Nice to Have
Minimum 1-3 years of experience in healthcare. Utilization Management experience. Microsoft Excel experience. Familiarity with the current Referral Management System (RMS). Customer Service skills. Familiarity with medical terminology and experience with ICD-10, HCPC and CPT codes. Medical Assistant Certification. Certified Nursing Assist (CNA). Certified Coding Associate (CCA). Certified Coding Specialist (CCS).
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Skills, education and keywords
Skills: Outlook, Microsoft Excel, Icd-10, HCPC, CPT, Medical Assistant Certification, Cna, Cca, CCS.
Education: High school diploma or equivalent (GED) required.
Frequently asked questions about Authorizations Coordinator I at Primed Business Consulting LLC
What does a Authorizations Coordinator I at Primed Business Consulting LLC do?expand_more
In this Authorizations Coordinator I at Primed Business Consulting LLC role, you will enter incoming verbal, mail, and efax requests for service using correct types and codes; answer phone queue line calls and monitor customer service requests within department standards; conduct outreach calls to provider offices and member notification calls for urgent requests; and process all incoming and outgoing correspondence and faxes within timeliness guidelines.
What are the requirements for this Authorizations Coordinator I role?expand_more
Primed Business Consulting LLC is looking for candidates who meet the following requirements: High school diploma or equivalent (GED); Accurate use of medical terminology and codes (ICD-10, HCPC and CPT); Knowledge and expertise in using Outlook email; Data entry and computer skills; and Ability to learn and adhere to health plan and regulatory compliance requirements for UM.
Where is the Authorizations Coordinator I role at Primed Business Consulting LLC located?expand_more
Authorizations Coordinator I at Primed Business Consulting LLC is based in Richards Boulevard, Sacramento, Sacramento County, California, 95814, United States. This is a on-site role.
Is this Authorizations Coordinator I job remote, hybrid, or on-site?expand_more
Primed Business Consulting LLC has listed this Authorizations Coordinator I role as on-site.
How much experience is required for this Authorizations Coordinator I role?expand_more
Authorizations Coordinator I at Primed Business Consulting LLC typically requires 1–3 years of relevant experience at the mid level level.
What skills do you need for the Authorizations Coordinator I role at Primed Business Consulting LLC?expand_more
Key skills for Authorizations Coordinator I at Primed Business Consulting LLC include Outlook; Microsoft Excel; Icd-10; HCPC; CPT; Medical Assistant Certification; Cna; and Cca.
What education is required for Authorizations Coordinator I at Primed Business Consulting LLC?expand_more
Educational requirements for this role: High school diploma or equivalent (GED) required.
What category does the Authorizations Coordinator I role belong to?expand_more
Authorizations Coordinator I at Primed Business Consulting LLC is part of the healthcare & nursing job category on Recrutus.