Medical Assistant

3 weeks ago

Orange, United States 9992 Full time $25 - $26
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 CalOptima Health 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 CalOptima Health’s prior authorization and referral process. Additionally, the incumbent will be responsible for applying CalOptima Health’s 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. 

- Work Arrangement: Full Office

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 Health’s 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 Health’s 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 short- and 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:
- Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Spanish, Vietnamese).
- Prior authorization and utilization management process experience (strongly preferred)

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.

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