- 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
- 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
- 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
- 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
- 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
-
Learning Management System
5 days ago
GAC Dubai, United Arab EmiratesJoin Our Team at GAC Corporate Academy · Are you ready to embark on an exciting journey with the GAC Group's ISO-certified corporate learning organization? Here's your chance to become a pivotal part of our dynamic team · GAC Corporate Academy, operating since February 2007 as a ...
-
Information Systems Manager
1 week ago
Hyatt Regency Dubai Creek Heights Dubai, United Arab EmiratesSummary · You will be responsible for the efficient running of the department in line with Hyatt International's Corporate Strategies and brand standards, whilst meeting employee, guest and owner expectations. The Information Systems Manager is responsible to ensure that all comp ...
-
Manager, Business Systems
1 day ago
Kerzner International Resorts Dubai, United Arab EmiratesManager, Business Systems · (10476) · At Kerzner, we never settle. Through continued innovation, our team of pioneers push until the next level is achieved, and then to keep going. Our philosophy is simple - we go above and beyond to Blow Away our Guest and Colleagues. Good enoug ...
-
Manager - Systems & Applications
1 week ago
Dubai Gold and Commodities Exchange Dubai, United Arab EmiratesManager - Systems & Applications · Job Purpose: · Key Accountabilities: · - Ensure **BOD and EOD Processes** are conducted as per scheduled to achieve agreed uptime. · - Responsible for **real-time** **monitoring and administration of Production and UAT systems** to ensure availa ...
-
System Administrator-manager
1 week ago
Talentfirst Human Resources Co Dubai, United Arab EmiratesA Dubai based IT firm is looking for below position for immediate joiner. · Position-**system Administrative Manager · - Cloud, storage and Backup** · **Job Description for Cloud, Storage & Backup** · - Manage and support Dell Storage datastores being present to ESXi hosts. · - W ...
-
Project Manager-elv System
1 week ago
Future vision communications llc Dubai, United Arab EmiratesHi · We are looking for project manager for elv system with following expertise. · 1. he should have proven track record of a project manager on his last employer. · 2. Minim 2-4 year experience as project manager on his last roll · 3. capable to handle small to medium level proj ...
-
Management Information System Officer
3 days ago
Aldar Academies Dubai, United Arab EmiratesAldar Education is currently seeking an outstanding **MIS Officer **to join Kent College Dubai. · As the leading education group in Abu Dhabi, we provide inclusive and innovative learning that inspires and empowers communities. We offer a range of brands for all learners in our c ...
-
Environmental Management System Officer
1 week ago
A3 Design LLC Dubai, United Arab Emirates**Designation**: EMS Officer · **Experience: 3** - 6 years · **Level of Position**:Mid Management · **Reporting to: HSE **Director · **Role**:EMS Officer, you will contribute to the sustainability and environmental strategies for the implementation of complex high-quality project ...
-
Manager - Enterprise System - Epm
1 week ago
DP World Dubai, United Arab Emirates**KEY ACCOUNTABILITIES** · - Provide Oracle Cloud EPM knowledge & dependencies. · - Manage project plan, coordinate status updates, and document/follow-up on key action items and decisions. · - Coordinate with various teams to drive, finalize and test functionality. · - Align Ora ...
-
Quality Management System, Officer
1 week ago
VHR Global Recruitment Dubai, United Arab Emirates**QMS OFFICER** · **DUBAI** · Performs Quality Management activities, surveillance, audits and spot checks of tools, parts, equipment and facility to ensure compliance with all directives leading to safe and compliance maintenance. · Collaborates with all departments to ensure cr ...
-
Security Systems Design Manager
1 week ago
DSP Consultants Dubai, United Arab EmiratesDSP Security and Technology Consultants in Dubai is looking for a Physical Security Design Manager for its Dubai office with the following description: · - Lead Physical Security design. · - Should be familiar with Design software's like AutoCAD and Revit. · - Ability to work und ...
-
ByteDance Dubai, United Arab EmiratesAbout Us · Founded in 2012, ByteDance's mission is to inspire creativity and enrich life. With a suite of more than a dozen products, including TikTok, Helo, and Resso, as well as platforms specific to the China market, including Toutiao, Douyin, and Xigua, ByteDance has made it ...
-
Product Operation Manager-information System
3 days ago
ByteDance Dubai, United Arab EmiratesAbout Us · Founded in 2012, ByteDance's mission is to inspire creativity and enrich life. With a suite of more than a dozen products, including TikTok, Helo, and Resso, as well as platforms specific to the China market, including Toutiao, Douyin, and Xigua, ByteDance has made it ...
-
DP World Dubai, United Arab EmiratesKEY ACCOUNTABILITIES: · - Leading the Product roadmap and enrichment of the Enterprise Workforce Management System · - Manage the rollouts, enhancements, and support of the enterprise workforce management systems across the group as per the business defined roadmap · - Build high ...
-
Product Manager-travel-information System
3 days ago
ByteDance Dubai, United Arab EmiratesAbout Us · Founded in 2012, ByteDance's mission is to inspire creativity and enrich life. With a suite of more than a dozen products, including TikTok, Helo, and Resso, as well as platforms specific to the China market, including Toutiao, Douyin, and Xigua, ByteDance has made it ...
-
Sales Manager for Dialysis and Renal Systems
1 week ago
HHD Health Care LLC Dubai, United Arab EmiratesAs a Sales Manager for Dialysis and Renal Systems, you will be responsible for driving sales and revenue growth within the healthcare sector. Your primary focus will be on promoting and selling our cutting-edge dialysis and renal system solutions to hospitals, clinics, and health ...
-
BeBright Dubai, United Arab EmiratesJob Title: Digital Signage Content Management System (CMS) and IoT Integration Specialist · **Job Description**: · **Responsibilities**: · *Manage and oversee the Digital Signage Content Management System (CMS) ensuring optimal content delivery across various platforms and displa ...
-
Marriott International, Inc Dubai, United Arab Emirates**Additional Information** Location Flexible: London, Eschborn or Dubai Office · **Job Number** · **Job Category** Finance & Accounting · **Location** Dubai Area Office, Central Park Towers Level 12, Dubai, United Arab Emirates, United Arab Emirates VIEW ON MAP · **Schedule** Fu ...
-
Virtua Advanced Solution Dubai, United Arab EmiratesCompany Description · Trans Skills is a trusted advisor to many of the Middle East's most respected organizations and a leading Human Resources Services Firm with an International Network active in 55 countries. Our clients range from the largest corporations to emerging growth c ...
-
Audio Visual Systems Sales Manager
5 days ago
Polymedia Dubai, United Arab EmiratesBachelor's Degree with 02-03 years of prospecting & sales of SMB scale Audio-Visual Systems Integration Projects in the UAE. · - Working project sales experience with vendors like Crestron, Extron, Atlona, Televic, Bosch, Bose, Barco, Daktronics, Unilumin, Epson, Smart, Aver, Pan ...
Financial Analyst System Management - Dubai, United Arab Emirates - Dice
Description
This position is temporary, lasting up to 6
Job Summary
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
Possesses the Ability To:
Requirements
Experience & Education
Preferred Qualifications
Knowledge of:
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
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