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Hill Physicians Medical Group · 1 day ago

Network Quality Coordinator (Hybrid) - 25-04

Sacramento, CA

Full-time

Hybrid

Mid Level

$27/hr - $30/hr

3+ years exp

Hill Physicians Medical Group is dedicated to shaping the future of healthcare through actively managed care. The Network Quality Coordinator role involves supporting the appeals and grievance process, managing case intake, outreach, and response tracking, as well as assisting with quality audit efforts and various administrative tasks.

Health CareMedicalProfessional Services

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)

Assists 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

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

Qualification

Managed care experiencePrior Authorization knowledgeEpic/Tapestry knowledgeSalesforce knowledgeTeam coordinationComputer proficiencyOrganizational skillsCommunication skills