Authorization Specialist

Authorization Specialist I

• Remote opportunity open to candidates residing in California
• Opportunity to make a difference in your community
• Position not eligible for sponsorship

General Description

Position supports the Health Services Department in the processing of incoming prior and concurrent authorization requests and verification of member plan eligibility. Will perform basic research on authorization requests including contacting providers to obtain clinical information.

Duties & Responsibilities
Essential Functions:

• Complete work within queues that are used to manage authorization requests.
• Handle calls to and from providers related to authorization requests.
• Contacting providers and requesting additional information for review based on requirement protocols when needed.
• Adhere to mandated timeliness requirements for processing urgent authorization requests.

• Follow-up on pended prior authorization requests or concurrent requests to comply with turnaround times consistent with Medi-Cal and Medicare requirements.
• Review authorization requests for completeness and appropriateness prior to forwarding to an assigned nurse.
• May create and collate routine reports (weekly, monthly, quarterly, and/or annually) for the
• Health Services Department.

Secondary Functions:

• Perform other duties as assigned.

Requirements

These are the qualifications typically needed to succeed in this position. However, you don’t need to meet every requirement to apply.

Education and experience

• High School diploma or GED required.
• One to two (1 -2) years of experience in the health care field or an equivalent combination of education and experience that would provide the required knowledge, skills, and abilities may qualify.

Knowledge of:

• Personal computers and proficiency in Microsoft Office Suite applications, including Outlook,
• Word, Excel, Access, and PowerPoint.

• Medical terminology or billing code procedures.
• General office equipment.

Ability to:

• Work cooperatively with others.
• Work as part of a team and support team decisions.
• Adapt to changes in requirements/priorities for daily and specialized tasks.
• Accurately file materials electronically.
• Perform general computer work including data entry, file creation, and file manipulation.
• Verify eligibility information utilizing various organizational sources (i.e. HEALTHsuite, Medi-Cal eligibility, MEDS); utilize multiple sources to verify prior authorization data accuracy. (i.e. duplicate requests).
• Organize work and meet deadlines and productivity standards.
• Report to South San Francisco, CA office on a quarterly basis (approximately 4 times per year).

Skills:

• Keyboard 45 words per minute

Salary and benefits

The starting salary range is $20.09 - $26.11 per hour, depending on the candidate’s work experience.

Excellent benefits package includes:

• HPSM-paid premiums for employee’s medical, dental and vision coverage (employee pays 10% of each dependent’s premiums)
• Fully paid life, AD&D and LTD insurance
• Retirement plan (HPSM contributes equivalent of 10% of annual compensation)
• 12 paid holidays a year, 12 paid sick days a year and paid vacation starting at 16 days a year
• Tuition reimbursement plan
• Employee wellness program

It is HPSM's policy to provide equal employment opportunity for all applicants and employees. HPSM does not unlawfully discriminate based on race, religion, color, national origin, ancestry, physical disability, mental disability, medical condition, marital status, sex, age, sexual orientation, veteran status, registered domestic partner status, genetic information, gender, gender identity, gender expression, or any other characteristic protected by applicable federal, state, or local law. HPSM also prohibits discrimination based on the perception that an applicant or employee has any of those characteristics or is associated with a person who has or is perceived to have any of those characteristics.

Job Type: Full-time

Pay: $20.09 - $26.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Employee discount
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Parental leave
• Professional development assistance
• Referral program
• Retirement plan
• Tuition reimbursement
• Vision insurance
• Wellness program

Weekly day range:

• Monday to Friday

Work Location: Hybrid remote in South San Francisco, CA 94080