Medical Authorization Assistant- Long Term Care

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.