Job Description
Job Description Medical Authorization Assistant (Con) Company Overview: Our client, a leading healthcare provider based in Orange, CA, is seeking a dedicated Medical Authorization Assistant, with a background in Concurrent Review.
Position Summary: We are looking for a qualified candidate with at least 2 years of health care experience with some degree of billing and coding, and concurrent review experience.
Work Duration: Up to 6 months
Job type: On-site
Position Responsibilities • Receives inpatient requests via fax, phone or electronically and enters data of new case information into the medical management system.
• Creates inpatient events based on facility face sheets and/or clinical received.
• Verifies member eligibility.
• Collects additional information from members and/or providers/facilities to complete prospective, concurrent or retrospective inpatient service reviews.
• Authorizes requested services according to Concurrent Review team guidelines.
• Contacts the health networks and/or CalOptima Health Customer Service department regarding health network enrollments.
• Assists the inpatient Medical Case Manager in gathering medical records, obtaining appropriate coding for diagnosis and procedures, discharge dates, dispositions and conducts follow-up phone calls per concurrent review team standards.
• Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
• Documents all contacts and case information in the system using the standard charting format.
• Enters data into the appropriate databases for monitoring and tracking, trending of inpatient events and other relevant databases as needed.
• Completes other projects and duties as assigned.
Required Experience and Education - High School diploma or equivalent
- 2 years of experience in a health care or managed care setting
Preferred Qualifications - Previous medical billing and coding experience.
- Certified Medical Assistant (CMA) Certification
- Concurrent review and utilization management experience strongly preferred.
- Bilingual in English and in one of the following languages: Arabic, Farsi, Chinese, Korean, Spanish, or Vietnamese.
Possesses the Ability To: - Develop rapport and establish and maintain effective working relationships with leadership and staff and external contacts at all levels and with diverse backgrounds.
- Work independently and exercise sound judgment.
- Communicate clearly and concisely, both orally and in writing.
- Work a flexible schedule; available to participate in evening and weekend events.
- Organize, be analytical, problem-solve and possess project management skills.
- Work in a fast-paced environment and in an efficient manner.
- Manage multiple projects and identify opportunities for internal and external collaboration.
- Motivate and lead multi-program teams and external committees/coalitions.
- Utilize computer and appropriate software (e.g., Microsoft Office: Excel, Outlook, PowerPoint, Word) and job-specific applications/systems to produce correspondence, charts, spreadsheets and/or other information applicable to the position assignment.
Sunshine Enterprise USA is an "Equal Opportunity Employer-Minorities, Females, Veterans and Disabled Persons" Sunshine Enterprise USA is an "Equal Opportunity Employer-Minorities, Females, Veterans and Disabled Persons"
Job Tags
Temporary work, Work at office, Flexible hours, Weekend work, Afternoon shift,