Medical Authorization Assistant - Concurrent - Sunshine Enterprise USA LLC

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

• 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, 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: Excel, Outlook, PowerPoint, Word) and job-specific 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”

Sunshine Enterprise USA is an “Equal Opportunity Employer—Minorities, Females, Veterans and Disabled Persons”