Medical Assistant - Authorization (Concurrent Review)

Equiliem 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. Equiliemhas 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 5 years running by our employees and client partners.
Job Summary
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 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.
Position Responsibilities

• 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.

Possesses the Ability To:

• 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.

Experience & Education

• 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 is also qualifying.

Preferred Qualifications

• Previous medical billing and coding experience.
• Certified Medical Assistant (CMA) certification.
• Concurrent Review and Utilization Management experience.
• Bilingual in English and in one of defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese).

Knowledge of:

• Medical terminology, International Classification of Diseases (ICD-10) and Current Procedural Terminology (CPT) coding.
• Medi-Cal and Medicare benefits and regulations