Responsibilities. This position will work 100% onsite at 801 Gateway Blvd., South San Francisco, CA Under direct supervision, respond to HPSM member and provider inquiries by telephone and other communication channels, providing members with comprehensive support regarding health plan benefits and services. Acts as the primary point of contact for members, delivering prompt, accurate, and courteous assistance via telephone and other communication...
Responsibilities. This position will work 100% onsite at 801 Gateway Blvd., South San Francisco, CA Under direct supervision, respond to HPSM member and provider inquiries by telephone and other communication channels, providing members with comprehensive support regarding health plan benefits and services. Acts as the primary point of contact for members, delivering prompt, accurate, and courteous assistance via telephone and other communication...
General Description. Serves as a member liaison, responsible for intaking and facilitating care coordination for HPSM members with Behavioral health treatment needs. The primary focus is responding to requests for behavioral health provider matching and guiding members that are receiving behavioral health care and linking members to appropriate providers. Spanish bilingual skills required. Qualifications. The following represents the typical way ...
General Description. Under the direction of the Director of Population Health, the Manager of Population Health Management (PHM) Manager is responsible for the ongoing development, implementation, and evaluation of HPSM’s PHM operational plans and programs ensuring alignment with departmental strategy. The Manager of PHM will oversee key PHM functions including population identification and assessments, alignment with delivery system supports, we...
Responsibilities. General Description The Health Equity Program Specialist supports implementation of HPSM’s Health Equity Strategy and CLAS Program activities including the design of interventions aimed at addressing health inequities and reducing health disparities among HPSM’s member population. HPSM’s Health Equity unit’s focus areas include Addressing Health Disparities, promoting culturally inclusive care, providing linguistically appropria...
Location: Hybrid (3 days onsite, 2 days at home) General Description Act as the primary point of contact for members of CareAdvantage D-SNP and CareAdvantage CMC and assist members with all aspects of plan benefits. Duties & Responsibilities Essential Functions. Provide customer service to CareAdvantage members primarily on the phone. Answer member questions about CareAdvantage health and prescription drug benefits, eligibility, and provider netw...
Responsibilities. Under direct supervision, respond to HPSM member and provider inquiries by telephone and other communication channels, providing members with comprehensive support regarding health plan benefits and services. Acts as the primary point of contact for members, delivering prompt, accurate, and courteous assistance via telephone and other communication channels, whether for general inquiries, concerns, or information requests about ...
Requirements. Under general supervision, the Claims Examiner II reviews and resolves a caseload of claims with varying degrees of complexity within established timeframes and using appropriate program policies and procedures. Reviews may include medical, dental, inpatient and/or DME claims that require intervention for pricing, documentation requirements, appropriate coding and benefit determinations. Position overview Essential Functions. Indepe...
General Description. The Health Promotion Services Temp supports the Health Promotion Unit by connecting HPSM members to various programs, resources, and services. Additionally, this position provides customer service directly to members, conducts member outreach, and processes requests for language assistance services. Qualifications. The following represents the typical way to achieve the necessary skills, knowledge and ability to qualify for t...
Claims Examiner I Under Close Supervision, The Claims Examiner I Will Perform Accurate Review, Entry And Processing Of All Claims Received For Payment By HPSM. Position Overview Essential Functions. Research rejected claims as necessary and re-adjudicated them when resolved. Claims entry of all standard claim forms. Correspond as required to resolve rejected claims. Review reports, verifying accurate data and making corrections as appropriate. Re...
General Description. Under general direction of the Government and Regulatory Affairs manager conduct internal and external audits that are routine and complex. Act as a subject matter expert resource to HPSM staff by providing a comprehensive explanation and interpretation of regulations and applicability to audits and audit findings. Qualifications. The following represents the typical way to achieve the necessary skills, knowledge and ability ...
