Network Quality Coordinator (Hybrid) - 26-74

Essential Responsibilities

• Monitoring of all incoming faxes via electronic fax system (Biscom/Faxcom)
• Performs administrative process for all member appeals in Epic authorization system (Tapestry) in accordance with health plan designated time frames (intake, outreach, response tracking)
• Performs administrative processes for all member complaints in electronic customer relationship management system (Salesforce) in accordance with health plan designated time frames (case intake, prep, practice outreach, practice response tracking)
• Monitoring of all Appeals and Grievance email communications
• Monitoring of all Appeals and Grievance phone calls and voicemails
• Coordination of all report requests
• Monitoring of customer relationship management (CRM) Appeals and Grievances queue via Epic authorization system (Tapestry)
• Aids in the development of quality audit tools for non-clinical roles and performs non-clinical audits
• May perform additional administrative functions to support Network Quality areas including but not limited to training support and development for non-clinical roles within HRM, compliance corrective action plans, Peer Review Subcommittee.

Non-Essential Responsibilities

• Establish and maintain effective lines of interdepartmental communication
• Exercise professionalism when communicating with senior leadership, outside business partners such as health plans, regulatory bodies, and provider offices.

Skills and Experience Required

• Minimum years of experience required: 3-5 years in related managed care experience
• Knowledge of Prior Authorization processes and regulatory requirements
• Preferred knowledge of Appeals & Grievances operations
• Minimum level of education required: High School diploma or GED
• Licenses and certifications required: none
• Ability to work independently as well as in a team environment
• Computer experience; proficiency in routine applications such as Word and Excel
• Epic/Tapestry and Salesforce knowledge a plus
• Excellent organizational and communication skills
• Ability to coordinate effectively with team and meet project timeframes

Additional Information

• Salary: $27 - $31 Hourly
• Location: Sacramento (Hybrid)
• Hill Physicians is an Equal Opportunity Employer