Impresiv Health
Medical Authorization Assistant, UM Prior Auth
Impresiv Health, Orange, California, United States, 92868
Title:
Medical Authorization Assistant, UM Prior Auth
Duration:
Up to 6 months
Compensation:
$23.92-$33.49/hour
Description:
The Medical Authorization Assistant (Prior Authorization) will provide office and referral management services and serve as a contact between members, physicians, providers and 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 the prior authorization and referral process. Additionally, the incumbent will be responsible for applying 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.
What You Will Do:
Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity, and accountability.
Receives referral requests via fax, phone or electronically and enters new service request information into the authorization system.
Collects additional information from members and providers to complete referral information.
Authorizes requested services according to the client's authorization guidelines, performing data entry into the authorization system and verifying eligibility.
Contacts the health networks and 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.
Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
Completes other projects and duties as assigned.
You Will Be Successful If:
Develop rapport and establish and maintain effective working relationships with CalOptima 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 (e.g., 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.
What You Will Bring:
High school diploma or equivalent required.
2+ years of experience in a health care or Managed Care setting required.
Bilingual in one of the following defined languages preferred: (Arabic, Chinese, Farsi, Korean, Spanish, Vietnamese).
Prior Authorization and Utilization Management process experience strongly preferred.
About Impresiv Health:
Impresiv Health is a healthcare consulting partner specializing in clinical & operations management, enterprise project management, professional services, and software consulting services. We help our clients increase operational efficiency by delivering innovative solutions to solve their most complex business challenges.
Our approach is and has always been simple. First, think and act like the customers who need us, and most importantly, deliver what larger organizations cannot do
provide tangible results that add immediate value, at a rate that cannot be beaten. Your success matters, and we know it.
That's Impresiv!
Medical Authorization Assistant, UM Prior Auth
Duration:
Up to 6 months
Compensation:
$23.92-$33.49/hour
Description:
The Medical Authorization Assistant (Prior Authorization) will provide office and referral management services and serve as a contact between members, physicians, providers and 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 the prior authorization and referral process. Additionally, the incumbent will be responsible for applying 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.
What You Will Do:
Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity, and accountability.
Receives referral requests via fax, phone or electronically and enters new service request information into the authorization system.
Collects additional information from members and providers to complete referral information.
Authorizes requested services according to the client's authorization guidelines, performing data entry into the authorization system and verifying eligibility.
Contacts the health networks and 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.
Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
Completes other projects and duties as assigned.
You Will Be Successful If:
Develop rapport and establish and maintain effective working relationships with CalOptima 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 (e.g., 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.
What You Will Bring:
High school diploma or equivalent required.
2+ years of experience in a health care or Managed Care setting required.
Bilingual in one of the following defined languages preferred: (Arabic, Chinese, Farsi, Korean, Spanish, Vietnamese).
Prior Authorization and Utilization Management process experience strongly preferred.
About Impresiv Health:
Impresiv Health is a healthcare consulting partner specializing in clinical & operations management, enterprise project management, professional services, and software consulting services. We help our clients increase operational efficiency by delivering innovative solutions to solve their most complex business challenges.
Our approach is and has always been simple. First, think and act like the customers who need us, and most importantly, deliver what larger organizations cannot do
provide tangible results that add immediate value, at a rate that cannot be beaten. Your success matters, and we know it.
That's Impresiv!