Medical Authorization Assistant, Concurrent Review

Title: Medical Authorization Assistant, Concurrent Review
Duration: up to 6 months
Compensation: $23.92 - $33.49/hour
Description: The Medical Authorization Assistant (Concurrent Review) will provide office and referral management support services, assist the inpatient Medical Case Managers in obtaining medical records, document all case information in the system, perform data entry into appropriate databases for monitoring and tracking and follow up on phone calls as directed by the Medical Case Managers. The incumbent will serve as the contact between members, physicians, facilities, providers and Health Plan staff. The incumbent will be responsible for processing the intake information and assisting with authorization functions. The incumbent will also perform office support functions as needed.
What You Will Do:

• Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity, and accountability.
• Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
• 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 Customer Service 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.
• 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.

You Will Be Successful If:

• Utilize Concurrent Review protocols to determine when to refer matters to licensed staff.
• Establish and maintain effective working relationships with leadership and staff.
• Communicate clearly and concisely, both orally and in writing.
• 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.
• Previous experience with medical billing and coding
• Certified Medical Assistant (CMA) certification, preferred
• Previous experience with concurrent review and utilization management
• Knowledge of Medi-Cal and Medicare benefits and regulations
• Bilingual in English and one of the following languages preferred (Arabic, Farsi, Chinese, Korean, Spanish, and Vietnamese)

What You Will Bring:

• High school diploma or equivalent
• 2+ years of experience in a health care or managed care setting
• ICD 10-CPT and HCPCS Coding certifications a plus
• Knowledge of medical terminology, ICD-10, and CPT coding required

About Impresiv Health:
Impresiv Health is a healthcare consulting partner specializing in clinical & operations management, enterprise project management, professional services, and software consulting services. We help our clients increase operational efficiency by delivering innovative solutions to solve their most complex business challenges.
Our approach is and has always been simple. First, think and act like the customers who need us, and most importantly, deliver what larger organizations cannot do - provide tangible results that add immediate value, at a rate that cannot be beaten. Your success matters, and we know it.
That's Impresiv!