Healthcare Operations Specialist

3 days ago

Los Angeles, California, United States University of California Full time
Job Summary

We are seeking a highly motivated and detail-oriented Prior Authorization Coordinator to join our team at UCLA Health.

As a Prior Authorization Coordinator, you will play a critical role in ensuring the efficient operation of our complex health system. You will be responsible for processing prior authorization requests with accuracy and timeliness, utilizing various business applications to perform analysis and enter data necessary for claims adjudication.

You will use your critical thinking skills to identify missing information and make prior authorization processing determinations based on clinical protocols and other guidelines. Additionally, you will interact with internal and external customers to provide and obtain information, ensuring the delivery of outstanding service and quality.

Responsibilities
  • Process prior authorization requests with accuracy and timeliness
  • Utilize various business applications to perform analysis and enter data necessary for claims adjudication
  • Identify missing information and make prior authorization processing determinations based on clinical protocols and other guidelines
  • Interact with internal and external customers to provide and obtain information
  • Ensure the delivery of outstanding service and quality
Requirements
  • High school diploma, GED or equivalent
  • One or more years of experience working in a managed care environment preferred
  • Experience processing ambulatory commercial, Medicare Fee for Service, Medicare Advantage prior authorizations a plus
  • Knowledge of the HMO referral process, eligibility verification, and health plan benefit interpretation desired
  • Strong communication, organizational, critical thinking, and problem-solving skills
  • Ability to work effectively across functional areas of the company
  • Excellent execution and follow-up abilities
  • Computer proficiency with Microsoft Office
  • Ability to multi-task, work with frequent interruptions, and meet deadlines
  • Detailed and goal-oriented
  • Ability to cope well with ambiguity and stressful situations
  • Ability to maintain confidentiality of patient and business records
About UCLA Health

UCLA Health is a world-renowned health system with four award-winning hospitals and more than 250 community clinics throughout Southern California. We are also home to the David Geffen School of Medicine, a highly respected leader in the development of breakthrough medical research and outstanding clinical professionals.

If you're looking to experience greater challenge and fulfillment in your career, you can at UCLA Health.

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