- Participatesin a mission-driven culture of high-quality performance, with amember focus on customer service, consistency, dignity and
- Assists the team in carrying outdepartment responsibilities and collaborates with others to supportshort- and long-term goals/priorities for the
- Receives referral request via fax,phone, or electronically and enters new service request informationinto the authorization
- Collectsadditional information from members and providers to completereferral
- Authorizes requestedservices according to authorization guidelines, performing dataentry into the authorization system, and verifying
- Contacts the health networks andCustomer Service regarding health network
- Assists the authorization nurse ingathering medical records, obtains appropriate coding for diagnosisand procedures, and follows up on phone calls as directed by theauthorization
- Documents allcontacts and case information in the system using the standardcharting
- Performs data entry intothe appropriate databases for monitoring, tracking, and trending ofevents, and other relevant databases as
- Completes other projects and dutiesas
- Explainand obtain relevant required data from members and providers torecord and summarize
- Communicateclearly and concisely, both orally and in
- Establish and maintain effectiveworking relationships with leadership and
- Use prior authorization protocolsto determine when to refer matters to a licensed staff
- Utilize computer and appropriatesoftware (, Microsoft Office: Word, Outlook, Excel, PowerPoint) andjob specific applications/systems to produce correspondence,charts, spreadsheets, and/or other information applicable to theposition
- HighSchool diploma or equivalent
- 2years of experience in a healthcare or Managed Care setting
- An equivalent combination ofeducation and experience sufficient to successfully perform theessential duties of the position such as those listed above is also
- Bilingualin English and in one of our defined threshold language (English,Spanish, Vietnamese, Farsi, Arabic, Korean, and Chinese)
- Prior Authorization and UtilizationManagement process knowledge
- Medical
- Medi-Cal and Medicare benefits and
- Current ICD 10- CPT, and HealthcareCommon Procedure Coding System (HCPCS) Coding continual updates toknowledge base regarding the
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Financial Analyst System Management - Dubai, United Arab Emirates - Dice
Description
This position istemporary, lasting up to6
JobSummary
TheMedical Authorization Assistant (MAA) provides office and referralmanagement The MAA serves as a contact between members, physicians,providers, and CalOptima Health staff, as well as processinginitial intake of information, assisting with authorizationfunctions, and gathering The incumbent is responsible for reviewingand processing requests for authorization and notification ofmedical services from health professionals, clinical facilities,and ancillary The incumbent is responsible for tasks related toprior authorization and referral The MAA is responsible forapplying our CalOptima Health s medical criteria andpolicies/procedures to authorization or referral requests frommedical professionals, clinical facilities, and ancillary Theincumbent directly interacts with provider callers, acting as aresource for their The MAA operates under the direction of thelicensed
PositionResponsibilities
Possesses theAbilityTo:
Requirements
Experience&Education
PreferredQualifications
Knowledgeof:
Benefits
AtSunshine Enterprise USA LLC, we firmly believe that our employeesare the heartbeat of our organization and we are happy to offer thefollowingbenefits:
Competitive pay& weeklypaychecks
Health, dental,vision, and lifeinsurance
401(k) savingsplan
Awards andrecognitionprograms
Benefiteligibility is dependent on employment
SunshineEnterprise USA is an Equal Opportunity Employer Minorities,Females, Veterans and Disabled Persons
Experience & Education High School diploma or equivalent 2years of experience in a healthcare or Managed Care setting Anequivalent combination of education and experience sufficient tosuccessfully perform the essential duties of the position such asthose listed above is also Preferred Qualifications Bilingual inEnglish and in one of our defined threshold language (English,Spanish, Vietnamese, Farsi, Arabic, Korean, and Chinese) PriorAuthorization and Utilization Management process knowledgeKnowledge of: Medical Medi-Cal and Medicare benefits and CurrentICD 10- CPT, and Healthcare Common Procedure Coding System (HCPCS)Coding continual updates to knowledge base regardingthe
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