Bilingual- Medical Authorization Assistant at Roth Staffing Companies in Orange, California

Job Description:

The Medical Authorization Assistant will provide office and case management support services by serving as a contact between members, physicians, nursing home facilities, community-based organizations, providers and staff. The incumbent will complete initial intake of information, assist with authorization functions and gather information. The incumbent will perform under the direction of the licensed Medical Case Managers, Social Workers, Program Mangers and department managers. The incumbent will provide effective and efficient communication with the utmost courtesy in every interaction with our members, employees and other customers.



Responsibilities


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.


Receives cases via mail, fax, phone or electronically and enters data for new case information into the medical management systems.


Conducts individual interviews with members and/or providers to obtain intake information and gather data.


Works with the Medical Case Manager to authorize requested services according to department guidelines and verifies eligibility through the state systems.


Contacts the health networks and/or Customer Service department regarding health network enrollments, changes in address and primary care provider.


Assists in gathering medical records, obtaining appropriate coding for diagnosis and procedures and follows up on phone calls.


Documents all contacts and case information in the appropriate medical management system using the standard charting format.


Performs data entry into the appropriate databases for monitoring and tracking, trending of cases and other relevant databases as needed.


Generates monthly and other required reports from the databases as requested by the Medical Case Manager and/or health networks.


Sends letters to providers and members.


Answers calls and provides customer service to providers and members, provides care coordination and refers the callers to the correct department.


Completes other projects and duties as assigned.


Possesses the Ability To:


Utilize prior authorization protocols to determine when to refer matters to a licensed staff member.


Obtain relevant data needed from members, providers, etc. and record and summarize findings.


Establish and maintain effective working relationships with leadership, staff, community agencies, providers and members.


Communicate clearly and concisely, both orally and in writing with individuals from varying cultural and ethnic backgrounds.


Utilize computer and appropriate software (e.g., Microsoft Office: Excel, Outlook, PowerPoint, Word) and job-specific applications/systems to produce correspondence, charts, spreadsheets and/or other information applicable to the position assignment.


Experience & Education


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 is also qualifying.


Preferred Qualifications


Certified Medical Assistant (CMA) certification.


Experience working with the needs of seniors or persons with disabilities (SPD) in a customer/member service capacity.


Previous medical billing or coding experience.


Utilization management experience.


Bilingual in English and in one of defined threshold languages (Arabic, Chinese, Farsi, Korean, Spanish, Vietnamese).


All