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CalAIM Authorization Coordinator

CalAIM Authorization Coordinator

LibertanaLos Angeles, CA, US
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Job Description

Job Description

Job Description

Position : Transitions Cal AIM Authorization Coordinator

Pay Range : $24-$26 hourly

Reporting To : Authorization Team Supervisor

Work Type : Hybrid

POSITION SUMMARY :

The Cal AIM Auth Coordinator is responsible for managing the intake of new members, processing billing and authorizations, and supporting various administrative functions for the CalAim and CCT departments.

QUALIFICATIONS :

  • Bachelor's degree in Healthcare Administration, Business Administration or related field preferred.
  • Has adequate computer experience in Microsoft Word and Excel.
  • 2+ years of Administration experience.
  • Is at least 18 years of age.
  • Excellent communication skills and ability to engage others.
  • Proper phone etiquette.
  • Experience in working with electronic healthcare systems.
  • Experience with developing reports.
  • Strong organizational and follow up skills

ESSENTIAL DUTIES AND RESPONSIBILITIES :

The following is a representation of the major duties and responsibilities of this position. The agency will make reasonable accommodations to allow otherwise qualified applicants with disabilities to perform essential functions.

  • Tracks and ensures referrals are processed within the time frames stated in the CalAim / CCT contract expectations.
  • Fields incoming calls and makes outgoing calls to all potential new members.
  • Reviews and compiles intake documents to ensure paperwork is properly completed andsubmitted to Health Plans for authorization.
  • Tracks and update authorization status for new members.
  • Performs eligibility screener in compliance with CalAim / CCT policies and procedures.
  • Works with other departments to identify gaps in care for members and generate internalreferrals.
  • Uses the different Managed Care Provider (MCP’s) portals to submit inital authorizationand reauthorizations requests for all CalAim services.
  • Has a clear understanding of services provided under CalAim (ECM and CS) and CCTwith the ability to clearly communicate them to potential members.
  • Creates patient charts and uploads referral and authorization documentation into theEMR system.
  • Processes approved authorizations and coordinates follow up activities for Case Managers
  • Provides updates to external care partners regarding patient status and / or other relevant information.
  • Completes CCT, CS, ECM visit logs and works through integration logs as needed.
  • Assists with completing DHCS CCT forms (ITCP, FTCP, DTRF) based on the RN assessment.
  • Assists in completing weekly and monthly CalAim MCP reports on CS Communications Log, CS Return Transmission File (RTF) and ECM Return Transmission File (RTF) & ECM Outreach Transmission File (OTF).
  • Conforms to all agency policies and procedures.
  • Maintains / conserves confidentiality of patient and agency information always with HIPAA regulations.
  • Regularly attends and participates in scheduled case conferences, staff meetings and agency in-services. (in person, by phone or on the web).
  • Follows policies and procedures as per Employee Handbook.
  • Maintains all required credentials up to date.
  • Reports Fraud and Abuse.
  • Knowledge of mandated reporting.
  • Conducts timely recording and / or documentation of client contact.
  • Performs other duties as assigned.

    • PHYSICAL REQUIREMENTS :

  • Stand, sit, talk, hear, reach, stoop, kneel and use of hands and fingers to operate computer, telephone, and keyboard on a frequent basis, up to 75% of the time.
  • Close vision requirements due to computer work.
  • Light to moderate lifting may be required up to 25lbs.
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    Authorization Coordinator • Los Angeles, CA, US

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