Medical Authorization Assistant

Job Description

Comments

Hourly Rate : $23.92 - $33.4880

Full Office : Monday-Friday

Hours : 8am-5pm

Job Summary

CalOptima Health is seeking a highly motivated an experienced Temp-Medical Authorization Assistant (UM Prior Auth) (2) to join our team.

The Medical Authorization Assistant (Prior Authorization) will provide office and referral management services and serve as a contact between members, physicians, providers and CalOptima Health staff.

The incumbent will process initial intake of information, assist with authorization functions and gather information. The incumbent will be responsible for reviewing and processing requests for authorization and notification of medical services from health professionals, clinical facilities and ancillary providers.

The incumbent monitor tasks related to CalOptima Health's prior authorization and referral process. Additionally, the incumbent will be responsible for applying CalOptima Health's medical criteria and policies / procedures to authorization or referral requests from medical professionals, clinical facilities and ancillary providers.

The incumbent will directly interact with provider callers, acting as a resource for their needs. The incumbent will operate under the direction of the licensed nurse.

Position Information :

• Department : Utilization Management
• Salary Grade : 302 - $23.92 - $33.4880
• Work Arrangement : Full Office

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.

• 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 mission-driven culture of high-quality 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% - Completes other projects and duties as assigned.

Minimum Qualifications :

High School diploma or equivalent

To apply please email your resume to [email protected]