What are the responsibilities and job description for the Medical Authorization Assistant- Long Term Care position at SUNSHINE ENTERPRISE USA LLC?
C ompany Overview : Our client a leading healthcare provider based in Orange CA is seeking a dedicated Medical Authorization Assistant with a background in Concurrent Review.
Position Summary : We are looking for a qualified candidate with at least 2 years of health care experience with some degree of billing and coding and concurrent review experience.
Work Duration : Up to 6 months
Job type : Onsite
Position Responsibilities
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 members and / or providers / facilities to complete prospective concurrent or retrospective inpatient service reviews.
Authorizes requested services according to Concurrent Review team guidelines.
Contacts the health networks and / or CalOptima 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 followup phone calls per concurrent review team standards.
Assists the team in carrying out department responsibilities and collaborates with others to support short and longterm 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.
Completes other projects and duties as assigned.
Required Experience and Education
High School diploma or equivalent
2 years of experience in a health care or managed care setting
Preferred Qualifications
Previous medical billing and coding experience.
Certified Medical Assistant (CMA) Certification
Concurrent review and utilization management experience strongly preferred.
Bilingual in English and in one of the following languages : Arabic Farsi Chinese Korean Spanish or Vietnamese.
Possesses the Ability To :
Develop rapport and establish and maintain effective working relationships with 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 : Excel Outlook PowerPoint Word) and jobspecific applications / systems to produce correspondence charts spreadsheets and / or other information applicable to the position assignment.
Sunshine Enterprise USA is an Equal Opportunity Employer Minorities Females Veterans and Disabled Persons
Proficiency in advanced anesthesia techniques for cardiac surgeries. Strong knowledge of critical care principles and management of cardiac conditions. Excellent communication and interpersonal skills, with the ability to work collaboratively in a fast-paced, high-pressure environment. Detail-oriented with strong organizational skills. Ability to make quick and informed decisions during medical emergencies.
Education
Minimum of 3 years of experience in cardiac anesthesia and ICU care, preferably in a hospital or healthcare setting with a high volume of cardiac surgeries. Demonstrated expertise in managing critically ill cardiac patients in the ICU.
