Habitat Health · 15 hours ago
Manager, Part C & Authorizations
San Francisco, CA, US
Full-time
Onsite
Mid, Senior Level
$119K/yr - $134K/yr
7+ years expHabitat Health is dedicated to enhancing the aging experience for older adults through comprehensive healthcare solutions. They are seeking a Manager for Part C & Authorizations to oversee adjudication operations, ensure the accuracy and quality of service authorizations, and collaborate across functions to drive continuous process improvement.
Health CareMedicalNutritionPersonal Health
Responsibilities
Oversees day-to-day adjudication operations, ensuring a controlled, disciplined, regulatorily compliant and exceptionally reliable operational environment that is timely, accurate, and has a high-quality output by internal team members and external vendors, as necessary
Responsible for establishing and maintaining reports that will support the efficacy of each service authorizations process activity and to produce a summary at least annually or upon request that includes statistical reports of activity, quality improvement activities, and utilization outcomes
Review and monitor encounter data submissions for accuracy, ensuring discrepancies are identified, corrected, and communicated through collaboration with cross functional teams; maintain documentation and troubleshooting processes to support data quality
Engages with Enrollment & Eligibility to resolve data discrepancies impacting member benefits or provider assignments. Partners with Provider Network on contract load timing, unclear terms, and pricing interpretation issues
Conduct retrospective reviews and maintains reporting that evaluates the accuracy, timeliness, and effectiveness of service authorization processes, providing clear summaries of findings and outcomes to leadership to drive continuous improvement
Monitors daily, weekly, and monthly inventory at the claim, and authorization and encounter data level to anticipate risk and maintain a stable production environment
Qualification
Required
7+ years of experience in health insurance operations, including team leadership and direct supervisory experience
Demonstrated expertise in claims processing and utilization management
Background in capitated health plan financials; PACE experience strongly preferred
Strong customer service orientation and ability to handle confidential information
Excellent verbal and written communication skills
Bachelor's degree in healthcare, finance, or related field required; Master's degree preferred
Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint)
Preferred
PACE experience strongly preferred
Master's degree preferred
Benefits
Health insurance
Life insurance
Participation in the company's equity program
Paid time off, including vacation and sick leave
Company
Habitat Health
Habitat Health provides health and social care to older persons with medical services.
51-200 employees
Funding
Current Stage
Growth StageTotal Funding
$50M2024-04-09Series Unknown· $50M
Recent News
Modern Healthcare
2025-02-15
Modern Healthcare
2025-01-03
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