Medical Authorization Assistant
Medical Authorization Assistant
Posted on :
21-11-2024
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1 Vacancy
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Job Description
Client: CalOptima Health
Job Title: Medical Authorization Assistant
Duration: 06 Months
Start Date: ASAP
Location: 505 City Parkway West Orange CA 92868 (Onsite)
Position Type: Contract
Interview Type: In Person/Web Interview
Ceipal ID: CALHD400IK
Position ID: 400
Job Title: Medical Authorization Assistant
Duration: 06 Months
Start Date: ASAP
Location: 505 City Parkway West Orange CA 92868 (Onsite)
Position Type: Contract
Interview Type: In Person/Web Interview
Ceipal ID: CALHD400IK
Position ID: 400
Department: MSSP (Multipurpose Senior Services Program)
Description:
- CalOptima Health is seeking a highly motivated an experienced TEMP Medical Authorization Assistant to join our team.
- The Medical Authorization Assistant (Multipurpose Senior Services Program) will provide office and case management support services.
- The incumbent will serve as a contact between members physicians providers and CalOptima Healths staff to gather information and serve as an interpreter as needed.
- Under the managers direction the incumbent will be responsible for providing effective efficient and courteous interaction with providers members and families and other CalOptima Health staff.
- The incumbent will perform medical administrative and routine tasks specific to the assigned program and may also perform administrative support functions.
Duties & Responsibilities:
80% Program Support
- Participates in a missiondriven culture of highquality performance with a member focus on customer service consistency dignity and accountability.
- Receives cases via fax phone or electronically and enters new case information into the MSSPCare Online and Jiva systems.
- Conducts individual interviews/assessments with CalOptima Health members and providers to obtain intake information.
- Obtains information on requested services according to CalOptima Healths services department guidelines performs data entry into MSSPCare Online and Jiva and verifies eligibility.
- Contacts the health networks and CalOptima Healths Customer Service regarding health network enrollments.
- Assists the Medical Case Managers and Social Workers in gathering medical records obtaining appropriate information on diagnoses and procedures and following up on phone calls.
- Documents all contacts and case information in the appropriate MSSPCare Online and Jiva scripts or activity as appropriate.
- Assists the Medical Case Managers and Social Workers with services arrangement including durable medical equipment and other services and items provided through insurance(s) and communitybased organizations.
- Performs highvolume data entry of 1915(c) Medicaid Waiver services into the MSSPCare online software system as well as other appropriate databases for tracking monitoring billing and trending of service utilization.
- Participates in a missiondriven culture of highquality performance with a member focus on customer service consistency dignity and accountability.
- Receives cases via fax phone or electronically and enters new case information into the MSSPCare Online and Jiva systems.
- Conducts individual interviews/assessments with CalOptima Health members and providers to obtain intake information.
- Obtains information on requested services according to CalOptima Healths services department guidelines performs data entry into MSSPCare Online and Jiva and verifies eligibility.
- Contacts the health networks and CalOptima Healths Customer Service regarding health network enrollments.
- Assists the Medical Case Managers and Social Workers in gathering medical records obtaining appropriate information on diagnoses and procedures and following up on phone calls.
- Documents all contacts and case information in the appropriate MSSPCare Online and Jiva scripts or activity as appropriate.
- Assists the Medical Case Managers and Social Workers with services arrangement including durable medical equipment and other services and items provided through insurance(s) and communitybased organizations.
- Performs highvolume data entry of 1915(c) Medicaid Waiver services into the MSSPCare online software system as well as other appropriate databases for tracking monitoring billing and trending of service utilization
15% Administrative Support
- Assists the team in carrying out department responsibilities and collaborates with others to support short and longterm goals/priorities for the department.
- Generates monthly and other required reports from the databases as requested by the Medical Case Managers Social Workers and/or health networks.
- Provides customer service to providers and members.
- Purchases delivers and/or retrieves items from vendors and/or MSSP participants as requested by the Medical Case Managers or Social Workers.
- Conducts inhome visits to retrieve signatures on care plans or other documents.
- Assists the team in carrying out department responsibilities and collaborates with others to support short and longterm goals/priorities for the department.
- Generates monthly and other required reports from the databases as requested by the Medical Case Managers Social Workers and/or health networks.
- Provides customer service to providers and members.
- Purchases delivers and/or retrieves items from vendors and/or MSSP participants as requested by the Medical Case Managers or Social Workers.
- Conducts inhome visits to retrieve signatures on care plans or other documents.
5% Completes other projects and duties as assigned.
Minimum Qualifications:
- High School diploma or equivalent required PLUS 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.
- Have access to means of transportation for work away from the primary office approximately 5% of the time.
Preferred Qualifications:
- 2 years of experience in invoice reconciliation and medical billing/coding required preferably for Medicaid/MediCal.
- 2 years of experience of data entry completion.
- Experience working with the needs of seniors or persons with disabilities (SPD) in a customer/member service capacity.
- Bilingual in English and in one of CalOptima Healths defined threshold languages (Arabic Farsi Chinese Korean Spanish Vietnamese).
Knowledge & Abilities:
- Develop rapport and establish and maintain effective working relationships with CalOptima Healths 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 problemsolve and possess project management skills.
- Work in a fastpaced environment and in an efficient manner.
- Manage multiple projects and identify opportunities for internal and external collaboration.
- Motivate and lead multiprogram 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.
Physical Requirements (With or Without Accommodations):
- Ability to visually read information from computer screens forms and other printed materials and information.
- Ability to speak (enunciate) clearly in conversation and general communication.
- Hearing ability for verbal communication/conversation/responses via telephone telephone systems and facetoface interactions.
- Manual dexterity for typing writing standing and reaching flexibility body movement for bending crouching walking kneeling and prolonged sitting.
- Lifting and moving objects patients and/or equipment 10 to 25 pounds
Work Environment:
- If located at the 500 505 Building or a remote work location:
- 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.
If located at PACE:
- Work is typically indoors in a clinical setting serving the frail and elderly.
- There may be harmful or hazardous environmental conditions present for this job.
- The noise level in this work environment is usually moderate to loud.
If located in the Community:
- Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours with travel as needed.
- Employee will occasionally work outdoors in varied temperatures.
- There may be harmful or hazardous environmental conditions present for this job.
- The noise level in this work environment is usually moderate to loud
V Group Inc. is an IT Services company that supplies IT staffing project management and delivery services in software network help desk and all IT areas. Our primary focus is the public sector including state and federal contracts. We have multiple awards/ contracts with the following states: CA FL GA MD MI NC NY OH OR PA SC VA and WA CT TN. If you are considering applying for a position with V Group or partnering with us on a position please feel free to contact me with any questions you may have regarding our services and the advantages we can offer you as a consultant.
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Employment Type
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