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Children’s Physicians Medical Group (CPMG) is a pediatric-only Independent Physicians Association (IPA), associated with Rady Children’s Hospital – San Diego. Its provider network includes 196 primary care pediatricians and 240 pediatric subspecialists. These providers in conjunction with Rady Children’s Hospital have formed an Integrated Delivery System (IDS) known as Rady Children’s Health Network (RCHN). Currently, 75,000 children are enrolled in CPMG through eight managed care Health Plan contracts and one Medi-Cal contract. Additionally, CPMG and its network partners provide MSO services to 400,000 other patients and their providers in San Diego, Southern Riverside, and Orange County.


Current Openings:

TO BE CONSIDERED FOR ANY OF THE FOLLOWING OPPORTUNITIES YOU MUST SUBMIT A LETTER OF INTEREST AND RESUME TO HUMAN RESOURCES AT cpmghr@rchsd.org.

Posted on Oct 3, 2017

Customer Service Representative

Full Time

Brief job description:

This position promotes favorable relationships with members, providers, and health plans through the prompt, accurate and courteous resolution of issues; receives and respond to customer inquiries (telephone, written and electronic) that may pertain to all phases of CPMG operations including authorizations, claims inquiries and provider network access; documents all customer contacts, including resolution or action taken to refer question to proper entity; assists and educates member families with navigation of HMO processes. The position will also include: Data entry/processing of authorization requests, including verification of benefits, research of authorization history, provider notes, use of correct CPT/ICD9 codes; providing referrals within CPMG network; working collaboratively with all professional entities relating to CPMG business; and assisting colleagues as necessary on special projects with time critical deadlines.

Minimum job qualifications (education, experience, certification, skills, etc):

  • High school degree or equivalent education with computer keyboarding skills.
  • Three (3) years experience working with Health Plans/Health Care.
  • Excellent verbal and written language skills to answer customer concerns in simple, understandable language.
  • Previous customer service experience in a physician office, hospital, or other healthcare setting.
  • The ability to work both independently and as part of a team, maintain confidentiality and exhibit a professional demeanor.

Preferred job qualifications:

  • Knowledge of health plan benefits, claims, ICD-9/CPT coding.