Medical Authorization Assistant

3 weeks ago


Orange, California, United States The Midtown Group Full time
Job Summary

The Midtown Group is seeking a highly motivated and experienced Medical Authorization Assistant to join our team. As a Medical Authorization Assistant, you 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.

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.
Requirements:
  • 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.
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 the defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese).
Work Environment:

The Midtown Group is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.



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