Summary:
Equiliem is seeking a highly motivated an experienced TEMP - Medical Authorization Assistant (LTC) to join our team. The Medical Authorization Assistant will provide office and case management support services by serving as a contact between members, physicians, nursing home facilities, community-based organizations, providers and staff. The incumbent will complete initial intake of information, assist with authorization functions and gather information. The incumbent will perform under the direction of the licensed Medical Case Managers, Social Workers, Program Mangers and department managers. The incumbent will perform medical administrative and/or routine tasks specific to the assigned program and may also perform office support functions. The incumbent will provide effective and efficient communication with the utmost courtesy in every interaction with our members, employees and other customers.
Job duties include, but are not limited to:
- 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 mail, fax, phone or electronically and enters data for new case information into the medical management systems.
- Conducts individual interviews with members and/or providers to obtain intake information and gather data.
- Works with the Medical Case Manager to authorize requested services according to department guidelines and verifies eligibility through the state systems.
- Contacts the health networks and/or Customer Service department regarding health network enrollments, changes in address and primary care provider.
- Assists in gathering medical records, obtaining appropriate coding for diagnosis and procedures and follows up on phone calls.
- Documents all contacts and case information in the appropriate medical management system using the standard charting format.
- Performs data entry into the appropriate databases for monitoring and tracking, trending of cases and other relevant databases as needed.
- Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
- Receives cases via mail, fax, phone or electronically and enters data for new case information into the medical management systems.
- Conducts individual interviews with members and/or providers to obtain intake information and gather data.
- Works with the Medical Case Manager to authorize requested services according to department guidelines and verifies eligibility through the state systems.
- Contacts the health networks and/or Customer Service department regarding health network enrollments, changes in address and primary care provider.
- Assists in gathering medical records, obtaining appropriate coding for diagnosis and procedures and follows up on phone calls.
- Documents all contacts and case information in the appropriate medical management system using the standard charting format.
- Performs data entry into the appropriate databases for monitoring and tracking, trending of cases and other relevant databases as needed.
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.
- Answers calls and provides customer service to providers and members, provides care coordination and refers the callers to the correct department.
- Sends letters to providers and members.
- Generates monthly and other required reports from the databases as requested by the Medical Case Manager and/or health networks.
- Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
- Answers calls and provides customer service to providers and members, provides care coordination and refers the callers to the correct department.
- Sends letters to providers and members.
- Generates monthly and other required reports from the databases as requested by the Medical Case Manager and/or health networks.
- Ability to visually read information from computer screens, forms and other printed materials and information.
- Ability to speak (enunciate) clearly in conversation and general communication.
- Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.
- Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
- Lifting and moving objects, patients and/or equipment 10 to 25 pounds
Completes other projects and duties as assigned.
Minimum Qualifications:
- High School diploma or equivalent required.
- 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.
Preferred Qualifications:
- Certified Medical Assistant (CMA) certification.
- Experience working with the needs of seniors or persons with disabilities (SPD) in a customer/member service capacity.
- Previous medical billing or coding experience.
- Utilization management experience.
- Bilingual in English and in one of the defined threshold languages (Arabic, Chinese, Farsi, Korean, Spanish, Vietnamese).
Knowledge & Abilities:
- 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: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
Shift:
To be discussed at interview. (Monday to Friday)
Contract:
Up to 6 months.
Equiliem Healthcare
specializes in staffing clinical, non-clinical, and allied personnel. We excel in all levels, disciplines, and specialties within the healthcare spectrum. Our projects range from short to long term local and travel assignments. Equiliem has been recognized as a certified small business enterprise. In addition, we are proud that we have earned the prestigious Joint Commission accreditation for staffing firms and have been awarded Best in Staffing 4 years running by our employees and client partners.
Benefits offered to our workers include the following:
- Medical Insurance
- Vision & Dental insurance
- Life Insurance
- 401K
- Commuter Benefits
- Employee Discounts & Rewards
- Payroll Payment Options
|
Equiliem
medical insurance, dental insurance, life insurance, 401(k)
Jan 09, 2025