Authorization Specialist

Essential Duties and Responsibilities include the following:

• “First line” resource for inpatient inquiries.
• Responsible for compiling coordinator audit questionnaires.
• Reflecting current processes and will be responsible for updating and maintaining the questionnaires as processes change.
• Review each case with the same expectations, providing necessary training to staff as trends in processing error are identified.
• Responsible for developing and maintaining resource material, job aids, auditing tools for all staff to reference as a guide when additional clarification is needed.
• Serve as front line support with inpatient and outpatient authorization requests, in effort to capture any leakage and continue to train staff in an effort to prevent and avoid leakage.
• Work in conjunction with campus Medical Director and HCC team to secure records for outpatient/elective cases for HCC coding.
• Develop a process utilizing. HMO/Passport to capture timely hospital admission for all line-of-business, to assist with early/timely case management.
• Work in collaboration with the department coordinators, Team Leads, Supervisor, Administrative Manager and Regional Medical Directors to assist with daily operations and management of inpatient coordinator duties, training, auditing functions, and assuring that all staff provides a level of patient service that meets or exceeds the organization’s expectation.
• Complete assigned tasks accurately and within specified time limits.
• Anticipate future events, set realistic goals, timetables, coordinate activities to ensure smooth work flow and time management.
• Identify and schedule ongoing training sessions for established staff to review processes with the department trainer where deficiencies appear in audits.
• Help to train new coordinators, nurses, physicians, medical directors, and necessary staff to rapidly learn the Organizations principles of Medical Management and to facilitate the right care at the right time in the right setting.
• Anticipate our provider’s needs:  Understand their wants and needs, listen for cues and identify how to respond and what level of intervention they need.           
• Returns phone calls to providers and follow up with requests in a timely fashion, as necessary with regards to tasks at hand.
• Recognizes when an error has been made and immediately correct it then report to appropriate manager.
• Consults other departments as appropriate to provide for an interdisciplinary approach to the patient’s needs.
• All other duties as directed by management.

The pay range for this position at commencement of employment is expected to be between $22 - $24 per hour; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.

The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.

Details of participation in these benefit plans will be provided if an employee receives an offer of employment.

If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.

As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.

Full Time Position Benefits:

The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.

Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.

Health and Wellness:

• Employer-paid comprehensive medical, pharmacy, and dental for employees
• Vision insurance
• Zero co-payments for employed physician office visits
• Flexible Spending Account (FSA)
• Employer-Paid Life Insurance
• Employee Assistance Program (EAP)
• Behavioral Health Services

Savings and Retirement:

• 401k Retirement Savings Plan
• Income Protection Insurance

Other Benefits:

• Vacation Time
• Company celebrations
• Employee Assistance Program
• Employee Referral Bonus
• Tuition Reimbursement
• License Renewal CEU Cost Reimbursement Program
• Business-casual working environment
• Sick days
• Paid holidays
• Mileage

Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.

Education and/or Experience:

• High school graduate required; Associates degree or higher preferred.
• Knowledge of Healthcare and Managed Care required.
• Typing 60 word per minutes with accuracy.
• Knowledge of computers, faxes, printers and all other equipment.
• Proficient in MS Office programs (i.e., Word, Excel, Outlook, Access and Power Point).
• Ability to deal with responsibility with confidential matters.
• Ability to work in a multi-task, high stress environment.
• Ability to prioritize.
• Ability to meet deadlines and ensure regulatory compliance.