Medical Authorization Assistant

For more details, please connect with Ibad Ullah Khan at 971-431-1753 or email at ibadkvgroupinc.com Client: Healthcare Job Title: Medical Authorization Assistant Duration: 06 Months Start Date: ASAP Location: 505 City Parkway West, Orange CA 92868 (Onsite) Position Type: Contract Interview Type: Web Interview Description: CalOptima Health is seeking a highly motivated an experienced Medical Authorization Assistant to join our team. The Medical Authorization Assistant (Multipurpose Senior Services Program) will provide office and case management support services. The incumbent will serve as a contact between members, physicians, providers and CalOptima Health’s staff to gather information and serve as an interpreter as needed. Under the manager’s direction, the incumbent will be responsible for providing effective, efficient and courteous interaction with providers, members and families and other CalOptima Health staff. The incumbent will perform medical administrative and routine tasks specific to the assigned program and may also perform administrative support functions. 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 MSSPCare Online and Jiva systems. Conducts individual interviews/assessments with CalOptima Health members and providers to obtain intake information. Obtains information on requested services according to CalOptima Health’s services department guidelines, performs data entry into MSSPCare Online and Jiva and verifies eligibility. Contacts the health networks and CalOptima Health’s 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 MSSPCare 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 MSSPCare 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 MSSPCare Online and Jiva systems. Conducts individual interviews/assessments with CalOptima Health members and providers to obtain intake information. Obtains information on requested services according to CalOptima Health’s services department guidelines, performs data entry into MSSPCare Online and Jiva and verifies eligibility. Contacts the health networks and CalOptima Health’s 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 MSSPCare 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 MSSPCare 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 participants as requested by the Medical Case Managers or Social Workers. Conducts in-home visits to retrieve signatures on care plans or other documents. 5% - Completes other projects and duties as assigned. Minimum Qualifications: High School diploma or equivalent required PLUS 2 years of experience in a health care or managed care setting required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. Have access to means of transportation for work away from the primary office approximately 5% of the time. Preferred Qualifications: 2 years of experience in invoice reconciliation and medical billing/coding required, preferably for Medicaid/Medi-Cal. 2 years of experience of data entry completion. Experience working with the needs of seniors or persons with disabilities (SPD) in a customer/member service capacity. Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese).