Opportunities for you!
Commitment to diversity and inclusion is a cornerstone of our culture at Community. All are welcome as valued members of our community.
We know that our ability to provide the highest level of care is through taking care of our incredible teams. Learn more on our Benefits page.
Responsibilities:Essential Accountabilities
Reflects the job's main responsibilities and is not intended to be an exhaustive list of all duties performed; therefore, its content does not restrict management's right to assign or reassign duties and responsibilities to individuals in this job.
Researches and processes prior authorization requests.
Verifies eligibility and benefits of members.
Performs data entry, prioritizes, and processes auto authorizations.
Monitors and follows-up on open or pended authorizations.
Enters demographic information into the system and updates information.
Prepares and maintains logs and reports.
Responds to and processes urgent/stat authorization requests.
Maintains confidentiality and discretion in use of member information.
Performs other job-related duties as assigned.
Knowledge, Skills, and Abilities
Knowledge of HMO commercial line of business.
Knowledge of HMO prior authorization requests, referral process, eligibility verification, and health plan benefits.
Ability to operate office equipment (e.g., telephone, fax, computer, scanner, etc.).
Skills in preparing and maintaining records, writing reports, and responding to correspondence.
Thorough and prompt follow-up up to resolution.
Excellent oral and written communication skills with proper use of grammar, spelling, and punctuation.
Ability to read, understand, and follow oral and written instructions.
Ability to multi-task, work with frequent interruptions, and meet deadlines.
Ability to establish and maintain effective working relationships.
Detailed and goal oriented.
Ability to work effectively in a team environment.
• Pay ranges listed are an estimate and subject to change.
• If any bonuses are noted, they are only applicable to external hires meeting criteria.
Community Health Systems, Inc. is a non-profit 501 (c) (3) 330 HRSA Grantee with Federally Qualified Health Center (FQHC) status. Established from the roots of Inland Empire Community Health Center in Bloomington, CHSI has grown with community health centers in the counties of Riverside, San Bernardino, and San Diego. These centers have been developed in accordance with standards established for safety net providers by the U.S. Department of Health and Human Services (HHS), the Health Resources Services Administration (HRSA), the Public Health Service (PHS), and the Bureau of Primary Health Care (BPHC).
As such, services are offered to the neediest in each community - the un-insured and under-insured, the working poor, those with limited ability to pay, the homeless, and the indigent. Services are provided at discounted (sliding fee scale) rates for those who qualify based on gross annual income and family size.