Medical Front Office

2 weeks ago


Orange, United States Cross Country Workforce Solutions Group Full time
Job DescriptionJob 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 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.

 

Position Information:

* Department: Utilization Management
* Work Arrangement: Full Office

 

Duties & Responsibilities:

Medical Authorization
* 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 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.

 

Administrative
* 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.

Company DescriptionCross Country Workforce Solutions Group (CCWSG) is a human resource, consulting and talent acquisition firm, specializing in PACE Programs, FQHCs/CHCs, and State Healthcare plans throughout the US. Our national operations center is located in Southern California.
CCWSG provides clinical and non-clinical staffing support to PACE centers across the country; we are the nation’s exclusive provider of non-medical, in-home caregivers for the elderly enrolled in PACE programs. Currently, we have over 3,000 caregivers supporting patients in their homes through PACE.
We are a part of the Cross Country Healthcare family, a market-leading workforce solutions, tech-enabled talent platform, and staffing, recruitment, and advisory firm with almost 40 years of industry experience and insight. We are a full-service partner, combining market expertise and services, including contingent staffing, consulting, human capital, management solutions, recruitment process outsourcing, vendor management, and direct hiring.Company DescriptionCross Country Workforce Solutions Group (CCWSG) is a human resource, consulting and talent acquisition firm, specializing in PACE Programs, FQHCs/CHCs, and State Healthcare plans throughout the US. Our national operations center is located in Southern California.\r
CCWSG provides clinical and non-clinical staffing support to PACE centers across the country; we are the nation’s exclusive provider of non-medical, in-home caregivers for the elderly enrolled in PACE programs. Currently, we have over 3,000 caregivers supporting patients in their homes through PACE.\r
We are a part of the Cross Country Healthcare family, a market-leading workforce solutions, tech-enabled talent platform, and staffing, recruitment, and advisory firm with almost 40 years of industry experience and insight. We are a full-service partner, combining market expertise and services, including contingent staffing, consulting, human capital, management solutions, recruitment process outsourcing, vendor management, and direct hiring.

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