Financial yst System Management

This position is temporary, lasting up to 6

The Medical Authorization Assistant (MAA) provides office and referral management The MAA serves as a contact between members, physicians, providers, and CalOptima Health staff, as well as processing initial intake of information, assisting with authorization functions, and gathering The incumbent is responsible for reviewing and processing requests for authorization and notification of medical services from health professionals, clinical facilities, and ancillary The incumbent is responsible for tasks related to prior authorization and referral The MAA is responsible for applying our CalOptima Health s medical criteria and policies/procedures to authorization or referral requests from medical professionals, clinical facilities, and ancillary The incumbent directly interacts with provider callers, acting as a resource for their The MAA operates under the direction of the licensed

Position Responsibilities

• Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and
  
• Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the
  
• Receives referral request via fax, phone, or electronically and enters new service request information into the authorization
  
• Collects additional information from members and providers to complete referral
  
• Authorizes requested services according to authorization guidelines, performing data entry into the authorization system, and verifying
  
• Contacts the health networks and Customer Service regarding health network
  
• Assists the authorization nurse in gathering medical records, obtains appropriate coding for diagnosis and procedures, and follows up on phone calls as directed by the authorization
  
• Documents all contacts and case information in the system using the standard charting
  
• Performs data entry into the appropriate databases for monitoring, tracking, and trending of events, and other relevant databases as
  
• Completes other projects and duties as
  

Possesses the Ability To:

• Explain and obtain relevant required data from members and providers to record and summarize
  
• Communicate clearly and concisely, both orally and in
  
• Establish and maintain effective working relationships with leadership and
  
• Use prior authorization protocols to determine when to refer matters to a licensed staff
  
• Utilize computer and appropriate software (, Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position
  

Requirements

Experience & Education

• High School diploma or equivalent
  
• 2 years of experience in a healthcare or Managed Care setting
  
• An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also
  

Preferred Qualifications

• Bilingual in English and in one of our defined threshold language (English, Spanish, Vietnamese, Farsi, Arabic, Korean, and Chinese)
  
• Prior Authorization and Utilization Management process knowledge
  

Knowledge of:

• Medical
  
• Medi-Cal and Medicare benefits and
  
• Current ICD 10- CPT, and Healthcare Common Procedure Coding System (HCPCS) Coding continual updates to knowledge base regarding the
  

Benefits

At Sunshine Enterprise USA LLC, we firmly believe that our employees are the heartbeat of our organization and we are happy to offer the following benefits:

Competitive pay & weekly paychecks

Health, dental, vision, and life insurance

401(k) savings plan

Awards and recognition programs

Benefit eligibility is dependent on employment

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