Medical Authorization Assistant at Roth Staffing Companies in Orange, California

Job Description:

Duties & Responsibilities:


- 80% - Program Support Participates in a mission-driven culture of high-quality 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 MSSP Care Online and Jiva systems. Conducts individual interviews/assessments with Company members and providers to obtain intake information. Obtains information on requested services according to Company services department guidelines, performs data entry into MSSP Care Online and Jiva and verifies eligibility. Contacts the health networks and Company 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 MSSP Care 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 community-based organizations. Performs high-volume data entry of 1915(c) Medicaid Waiver services into the MSSP Care online software system, as well as other appropriate databases, for tracking, monitoring, billing and trending of service utilization.


- Participates in a mission-driven culture of high-quality 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 MSSP Care Online and Jiva systems.


- Conducts individual interviews/assessments with Company members and providers to obtain intake information.


- Obtains information on requested services according to Company services department guidelines, performs data entry into MSSP Care Online and Jiva and verifies eligibility.


- Contacts the health networks and Company 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 MSSP Care 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 community-based organizations.


- Performs high-volume data entry of 1915(c) Medicaid Waiver services into the MSSP Care 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 long-term 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 in-home 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 long-term 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 participan