Medical Authorization Assistant- Long Term Care

Medical Authorization Assistant

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"