Medical Authorization Assistant, LT care - Sunshine Enterprise USA LLC

Medical Authorization Assistant – Long Term Care

Company Overview: Our client, a leading healthcare provider based in Orange, CA, is seeking a dedicated Medical Authorization Assistant, who will assist with authorization functions and gather information.

Position Summary: We are looking for a qualified candidate with at least 2 years of experience in medical billing/coding, data entry and invoice reconciliation.

Work duration: Up to 6 months

Job type: On-site

Position Responsibilities

• Receives cases via fax, phone or electronically and enters new case information into the MSSPCare Online and Jiva systems.
• Conducts individual interviews/assessments with members and providers to obtain intake information.
• Obtains information on requested services according to department guidelines, performs data entry into MSSPCare Online and Jiva and verifies eligibility
• Contacts the health networks and Customer Service regarding health network enrollments.
• Assists the Medical Case Managers and Social Workers in gathering medical records, obtaining appropriate information on diagnoses and procedures and following up on phone calls.
• Documents all contacts and case information in the appropriate MSSPCare Online and Jiva scripts or activity as appropriate.
• Performs data entry into the appropriate databases for monitoring and tracking, trending of cases and other relevant databases as needed.
• Generates monthly and other required reports from the databases as requested by the Medical Case Managers, Social Workers and/or health networks.
• Completes other projects and duties as assigned.

Minimum Qualifications

• High School diploma or equivalent
• 2 years of experience in a health care or managed care setting required with seniors or persons with disabilities in a customer/member service capacity.
• 2 years of experience in medical billing or coding experience.
• Utilization management experience preferred.
• Bilingual in English and in one of the following languages preferred: Arabic, Farsi, Chinese, Korean, Spanish, or Vietnamese.

Possesses the Ability To:

• Develop rapport and establish and maintain effective working relationships with leadership and staff and external contacts at all levels and with diverse backgrounds.
• Work independently and exercise sound judgment.
• Communicate clearly and concisely, both orally and in writing.
• Work a flexible schedule; available to participate in evening and weekend events.
• Organize, be analytical, problem-solve and possess project management skills.
• Work in a fast-paced environment and in an efficient manner.
• Manage multiple projects and identify opportunities for internal and external collaboration.
• Motivate and lead multi-program teams and external committees/coalitions.
• Utilize computer and appropriate software (e.g., Microsoft Office: Excel, Outlook, PowerPoint, Word) and job-specific applications/systems.

Sunshine Enterprise USA is an “Equal Opportunity Employer—Minorities, Females, Veterans and Disabled Persons”