MEDICAL AUTHORIZATION ASSISTANT- LONG TERM CARE

Job Description

Company 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 : On-site

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 follow-up phone calls per concurrent review team standards.
• 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.
• Completes other projects and duties as assigned.

Required Experience and Education

Preferred Qualifications

Possesses the Ability To :

Sunshine Enterprise USA is an Equal Opportunity Employer-Minorities, Females, Veterans and Disabled Persons