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Hourly Rate: $23.92 - $33.48

Job Summary

We are Seeking a highly motivated and experienced Medical Authorization Assistant to join our team. The Medical Authorization Assistant (Concurrent Review) will provide office and referral management support services, assist the 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. The incumbent will serve as the contact between members, physicians, facilities, providers, The incumbent will be responsible for processing the intake information and assisting with authorization functions. The incumbent will also perform office support functions as needed.

Position Information:
Department: Utilization Management
Hourly Rate: $23.92 - $33.48
Work Arrangement: Full Office

Duties & Responsibilities:
85% - Medical Authorization
Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity, and accountability.
Receives inpatient requests via fax, phone, or electronically and enters data of new case information into the medical management system.
Creates inpatient events based on facility face sheets and/or clinical received.
Verifies member eligibility.
Collects additional information from Company Health members and/or providers/facilities to complete prospective, concurrent, or retrospective inpatient service reviews.
Authorizes requested services according to Company Health's Concurrent Review team guidelines.
Contacts the health networks and/or Company Health Customer Service department regarding health network enrollments.
Assists the inpatient Medical Case Manager in gathering medical records, obtaining appropriate coding for diagnosis and procedures, discharge dates, dispositions, and conducts follow-up phone calls per concurrent review team standards.

10% - 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.
Documents all contacts and case information in the system using the standard charting format.
Enters data into the appropriate databases for monitoring and tracking, trending of inpatient events, and other relevant databases as needed.

5% Completes other projects and duties as assigned.

Minimum Qualifications:
High School diploma or equivalent required.
2 years of experience in a health care or managed care setting required.

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 Company Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese).

Required Licensure / Certifications:
N/A

Knowledge & Abilities:
Develop rapport and establish and maintain effective working relationships with Company Health's 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, problem-solve, and possess project management skills.
Work in a fast-paced environment and in an efficient manner.
Manage multiple projects and identify opportunities for internal and external collaboration.
Motivate and lead multi-program 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 face-to-face 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.

All qualified applicants will receive consideration for employment without regard to race, color, national origin, age, ancestry, religion, sex, sexual orientation, gender identity, gender expression, marital status, disability, medical condition, genetic information, pregnancy, or military or veteran status. We consider all qualified applicants, including those with criminal histories, in a manner consistent with state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance.