Medical Authorization Assistant - Orange, United States - Sumeru Inc

Sumeru Inc

Verified Company

Orange, United States

2 weeks ago

Posted by:

Mark Lane

beBee recruiter

Description

Client:
CalOptima Health

Job Title:
Medical Authorization Assistant

Duration: 06 Months

Start Date:
ASAP

Location: 505 City Parkway West, CA

Position Type:
Contract

Interview Type:
In Person/Web Interview

Ceipal ID:
CAL_HD416_BT

Description:

Duties & Responsibilities:

85% Medical Authorization
Receives referral requests via fax, phone or electronically and enters new service request information into the authorization system.
Collects additional information from CalOptima Health members and providers to complete referral information.
Authorizes requested services according to CalOptima Health's authorization guidelines, performing data entry into the authorization system and verifying eligibility.
Contacts the health networks and CalOptima Health Customer Service regarding health network enrollments.
Assists the Medical Case Managers in gathering medical records, obtains appropriate coding for diagnosis and procedures and follows up on phone calls as directed by the authorization nurse.
Documents all contacts and case information in the system using the standard charting format.
Performs data entry into the appropriate databases for monitoring, tracking and trending of events and other relevant databases as needed.
10% Administrative Support
Participates in a missiondriven culture of highquality performance, with a member focus on customer service, consistency, dignity and accountability.
Assists the team in carrying out department responsibilities and collaborates with others to support short

- and long-term goals/priorities for the department.

5% Other
Completes other projects and duties as assigned.

Minimum Qualifications:

High School diploma or equivalent required.
2 years of experience in a health care or managed care setting required.
An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.

Preferred Qualifications:

Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Spanish, Vietnamese)
Prior authorization and utilization management process experience.

Knowledge & Abilities:

Develop rapport and establish and maintain effective working relationships with CalOptima Health's 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, problemsolve and possess project management skills.
Work in a fastpaced environment and in an efficient manner.
Manage multiple projects and identify opportunities for internal and external collaboration.
Motivate and lead multiprogram teams and external committees/coalitions.