Health Plan Authorization Representative

Health Plan Authorization Representative

Contra Costa County Health is seeking to fill two (2) Health Plan Authorization Representative positions located at Contra Costa Health Plan (CCHP) in Martinez, CA.

The Contra Costa Health Plan Authorizations Unit processes authorization requests for medical care / services for health plan members. Good pay and benefits are a plus. The Health Plan Authorization Representative is responsible for obtaining all necessary documentation required to process requests for medical treatments and services; for preparation of correspondence and maintenance of documents related to authorization approvals, denials, and other outcomes; and for assisting providers in understanding the authorization processes.

This position receives day-to-day supervision by the Health Plan Utilization Review Coordinator functioning as the Authorization Unit Supervisor and Utilization Manager.

CCHP has been serving the health needs of people in the County for 40 years. CCHP was the first federally qualified, state-licensed, county-sponsored healthcare maintenance organization (HMO) in the United States. In 1973, CCHP became the first county-sponsored health plan in California to offer Medi-Cal Managed Care coverage and in 1976, we became the first county-run HMO to serve Medicare beneficiaries. In the 1980's, we expanded our programs to reach out to county employees, businesses, individuals, and families. In 2014 as part of the implementation of the Affordable Care Act, CCHP enrolled over 35,000 newly eligible individuals into Medi-Cal Managed Care, and in 2015 over 25,000 more individuals enrolled into CCHP Medi-Cal Managed Care.

We are looking for someone who :

• Exhibits professionalism and self-motivation
• Communicates effectively with the ability to explain, verify, and clarify information to process authorization requests
• Has knowledge of Health Plan coverage and benefits
• Maintains patient confidentiality
• Completes assigned duties within the required regulatory timeframes

What you will typically be responsible for :

A few reasons why you might love this job :

A few challenges you might face in this job :

Competencies Required :

Minimum Qualifications :

Education : High School diploma or GED required. Experience : Twelve (12) months of full-time or its equivalent experience processing requests for medical services and / or prescription drugs in an authorization unit of a health plan or medical group or in a hospital or pharmacy setting OR twelve (12) months of full-time or its equivalent experience performing administrative and / or basic clinical duties in a medical office. Substitution : Successful completion of one of the following accredited educational programs : Medical Assistant; Medical Office Professional; or Pharmacy Technician. Other Requirements : Must be able to type a minimum of 40 words per minute.

Selection Process :

Application Filing and Evaluation : Applicants will be required to complete a supplemental questionnaire at the time of application. Applications will be evaluated to determine which candidates will move forward in the next phase of the recruitment process. Online Typing Test : Qualified candidates will be emailed a link to take a typing test. Online Multiple-Choice Exam : Qualified candidates that meet the minimum 40 words per minute typing test will be invited to participate in a multiple-choice assessment. The assessment is designed to measure candidates' competencies as they relate to the job. These may include but are not limited to Attention to Detail, Self-Management, Critical Thinking, and Customer Focus. The assessment will be administered remotely using a computer. You will need access to a reliable internet connection to take the assessment. It is not recommended to take the assessment using a cell phone.

Tentative Exam Dates

Remote Typing Test : 10 / 21 / 25 - 10 / 24 / 25

Remote Exam / Evaluation : 11 / 3 / 25-11 / 6 / 25

For recruitment questions, please contact Health Services Personnel, Recruitment Team at Exams@cchealth.org. For any technical issues, please contact the Government Jobs' applicant support team for assistance at +1 855-524-5627.

The Human Resources Department may change the examination steps noted above in accordance with the Personnel Management Regulations and accepted selection practices.

After you receive a conditional job offer, you will be fingerprinted, and your fingerprints will be sent to the California Department of Justice (DOJ) and the Federal Bureau of Investigation (FBI). The resulting report of your conviction history (if any) will be used to determine whether the nature of your conviction conflicts with the specific duties and responsibilities of the job for which you have received a conditional job offer. If a conflict exists, you will be asked to present any evidence of rehabilitation that may mitigate the conflict, except when federal or state regulations bar employment in specific circumstances. Having a conviction history does not automatically preclude you from a job with Contra Costa County. If you accept a conditional job offer, the Human Resources Department will contact you to schedule a fingerprinting appointment.

All Contra Costa County employees are designated Disaster Service Workers through state and local law. Employment with the County requires the affirmation of a loyalty oath to this effect. Employees are required to complete all Disaster Service Worker-related training as assigned, and to return to work as ordered in the event of an emergency.

It is the policy of Contra Costa County to consider all applicants for employment without regard to race, color, religion, sex, national origin, ethnicity, age, disability, sexual orientation, gender, gender identity, gender expression, marital status, ancestry, medical condition, genetic information, military or veteran status, or other protected category under the law.