Supervisor, Utilization Management – Authorizations - 26-107

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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