Job Details

Client: CalOptima Health

Job Title: Medical Authorization Assistant

Duration: 06 Months

Start Date: ASAP

Location: 505 City Parkway West, CA(Onsite)

Position Type: Contract

Job Description:

CalOptima Health is seeking a highly motivated an experienced TEMP - Medical Authorization Assistant (CCR) (RTF 006) to join our team.

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 CalOptima 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:

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 Healths 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 Healths 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 shortand long-term goals/priorities for the department.

5% Completes other projects and duties as assigned.

Minimum Qualifications:

High School diploma or equivalent required.

2 years of experience in a health care or managed care setting required.

An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.

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 CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese).

Knowledge & Abilities:

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.