Prior Authorization Coordinator
San Francisco Health Plan
Join us at San Francisco Health Plan (SFHP) and make a difference with the under-served SF communities. Reporting to the Manager of Prior Authorization, the Prior Authorization (PA) Coordinator works with the PA nurses and provider offices to help ensure review of coverage authorization requests for our members. The responsibilities of this position include data entry, inbound and outbound telephone contact with providers, maintaining security of Protected Health Information (PHI), and processing authorization approvals that do not require clinical review. You will provide opportunities to contribute to multiple projects and cross-training for Concurrent Review authorization processing contingent upon departmental needs.
WHAT YOU WILL DO:
- Manage incoming coverage authorization requests, entering them into the authorization software or re-directing them to appropriate entities outside SFHP.
- Process authorization requests using SFHP procedures and electronic resources and refers cases to the Prior Authorization Nurse for medical necessity or benefit review within mandated regulatory timeframes.
- Work with provider, facility and vendor office and delegated group staff to promptly answer questions and resolve issues related to authorizations.
- Maintain accurate documentation of provider calls within authorization records.
- Maintain databases for reporting requirements.
WHAT YOU WILL BRING:
- One year of experience with state and federal insurance programs from a provider or payer setting.
- A Bachelor's degree in Social Sciences, Life Sciences, Business or a related field or equivalent work experience.
- Knowledge of medical terminology and familiarity with diagnosis and service codes (ICD/CPT/HCPCS).
- Experience with health information system applications and Microsoft Office products.
- Medical Plans: You’ll have a choice of medical plans, including options from Kaiser and Blue Shield of California. Employee-only coverage in the HMO plans is currently available at no cost and dependent coverage is heavily subsidized by SFHP.
- Dental: You’ll have a choice of a basic dental plan or an enhanced dental plan which includes orthodontic coverage.
- Vision: Employee vision care coverage is available at no cost.
- Time Off: 23 days of Paid Time Off and 12 observed company holidays.
- Professional development: Opportunities for tuition reimbursement, professional license/membership.
Established in 1994, San Francisco Health Plan (SFHP) is an award winning, managed care health plan whose mission is to provide affordable health care coverage to the underserved low and moderate-income residents in San Francisco county. SFHP is chosen by eight out of every ten San Francisco Medi-Cal managed care enrollees and its 170,000+ members have access to a full spectrum of medical services including preventive care, specialty care, hospitalization, prescription drugs, and family planning services. SFHP was designed by and for the residents it serves, and takes great pride in its ability to accommodate a diverse population that includes young adults, seniors, and people with disabilities.
San Francisco Health Plan is proud to be an equal opportunity employer. We are committed to a work environment that supports, inspires, and respects all individuals and in which our people processes are applied without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military service status, citizenship, or other protected characteristics.
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
San Francisco Health Plan is an E-Verify participating employer.
Hiring priority will be given to candidates residing in the San Francisco Bay Area and California.