Medical Authorization Assistant

Client Summary : Our client is the single largest health plan in Orange County, serving one in four residents. Our motto "Better.

Together. is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health.

Job Description : Medical Authorization Assistant

The Medical Authorization Assistant (Concurrent Review) will provide office and referral management support services, assist the inpatient Medical Case Managers in obtaining medical records, document all case information in the system, perform data entry into appropriate databases for monitoring and tracking, and follow up on phone calls as directed by the Medical Case Managers.

The incumbent will serve as the contact between members, physicians, facilities, providers, and the company Health staff.

The incumbent will be responsible for processing the intake information and assisting with authorization functions. The incumbent will also perform office support functions as needed.

Duties & Responsibilities : % - Medical Authorization

• Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity, and accountability.
• 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 company members and / or providers / facilities to complete prospective, concurrent, or retrospective inpatient service reviews.
• Authorizes requested services according to the company Health's Concurrent Review team guidelines.
• Contacts the health networks and / or the company's 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.

Administrative Support

• 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.

Minimum Qualifications :

• High School diploma or equivalent required.
• years of experience in a health care or managed care setting required.

Preferred Qualifications :

• Previous medical billing and coding experience.
• Certified medical assistant (CMA) certification.
• Concurrent review and utilization management experience.
• Bilingual in English and in one of the company's Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese).

Knowledge & Abilities :

• Develop rapport and establish and maintain effective working relationships with the company's 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, 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 (, Microsoft Office : Word, Outlook, Excel, PowerPoint) and job-specific applications / systems to produce correspondence, charts, spreadsheets, and / or other information applicable to the position assignment.

Physical Requirements (With or Without Accommodations) :

• Ability to visually read information from computer screens, forms, and other printed materials and information.
• Ability to speak (enunciate) clearly in conversation and general communication.
• Hearing ability for verbal communication / conversation / responses via telephone, telephone systems, and face-to-face interactions.
• Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling, and prolonged sitting.
• Lifting and moving objects, patients, and / or equipment to pounds.

Work Environment :

• Work is typically indoors and sedentary and is subject to schedule changes and / or variable work hours, with travel as needed.
• There are no harmful environmental conditions present for this job.
• The noise level in this work environment is usually moderate.

Schedule Notes : TBD