Judge Healthcare is seeking a Medical Authorization Assistant for Concurrent Reviews in Orange, CA!
Position Responsibilities:
Foster a mission-driven culture focused on high-quality performance, emphasizing customer service, consistency, dignity, and accountability.
Collaborate with the team to fulfill departmental responsibilities and support both short- and long-term goals.
Receive inpatient requests via fax, phone, or electronically, and enter new case information into the medical management system.
Create inpatient events based on facility face sheets and/or received clinical information.
Verify member eligibility.
Collect additional information from Health members and/or providers/facilities to complete prospective, concurrent, or retrospective inpatient service reviews.
Authorize requested services according to Health's Concurrent Review team guidelines.
Contact health networks and/or Health Customer Service regarding health network enrollments.
Assist the inpatient Medical Case Manager in gathering medical records, obtaining appropriate coding for diagnoses and procedures, discharge dates, dispositions, and conducting follow-up phone calls per concurrent review team standards.
Document all contacts and case information in the system using the standard charting format.
Enter data into relevant databases for monitoring, tracking, and trending of inpatient events.
Minimum Qualifications:
High School diploma or equivalent.
2 years of experience in a healthcare or managed care setting.
An equivalent combination of education and experience sufficient to perform the essential duties of the position.
Preferred Qualifications:
Experience in medical billing and coding.
Certified Medical Assistant (CMA) certification.
Experience in concurrent review and utilization management.
Bilingual in English and one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese).
If this sounds like something you'd be interested in hearing more about, please apply directly for immediate consideration. For additional information or questions, please reach out to Jacob at jmaybrier@judg.com