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Medical Authorization Assistant
1 month ago
The Medical Authorization Assistant will provide office and referral management support services, assist 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 staff. The incumbent will be responsible for processing intake information and assisting with authorization functions. The incumbent will also perform office support functions as needed.
Key Responsibilities- Participate in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity, and accountability.
- Receive inpatient requests via fax, phone, or electronically and enter data of new case information into the medical management system.
- Create inpatient events based on facility face sheets and/or clinical received.
- Verify member eligibility.
- Collect additional information from members and/or providers/facilities to complete prospective, concurrent, or retrospective inpatient service reviews.
- Authorize requested services according to Concurrent Review team guidelines.
- Contact the health networks and/or the Customer Service department regarding health network enrollments.
- Assist the inpatient Medical Case Manager in gathering medical records, obtaining appropriate coding for diagnosis and procedures, discharge dates, dispositions, and conduct follow-up phone calls per concurrent review team standards.
- High School diploma or equivalent required.
- 2 years of experience in a healthcare or managed care setting required.
- An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position may also be qualifying.
- Previous medical billing and coding experience.
- Certified medical assistant (CMA) certification.
- Concurrent review and utilization management experience.
- Bilingual in English and in one of the defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese).
Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
There are no harmful environmental conditions present for this job.
The noise level in this work environment is usually moderate.
