This position is temporary, lasting up to 6 months.

Medical Authorization Assistant - Temp

Job Summary

The Medical Authorization Assistant (MAA) provides office and referral management services. The MAA serves as a contact between members, physicians, providers, and staff, as well as processing initial intake of information, assisting with authorization functions, and gathering information. The incumbent is responsible for reviewing and processing requests for authorization and notification of medical services from health professionals, clinical facilities, and ancillary providers. The incumbent is responsible for tasks related to prior authorization and referral process. The MAA is responsible for applying our medical criteria and policies/procedures to authorization or referral requests from medical professionals, clinical facilities, and ancillary providers. The incumbent directly interacts with provider callers, acting as a resource for their needs. The MAA operates under the direction of the licensed nurse.

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 referral request via fax, phone, or electronically and enters new service request information into the authorization system.
• Collects additional information from members and providers to complete referral information.
• Authorizes requested services according to authorization guidelines, performing data entry into the authorization system, and verifying eligibility.
• Contacts the health networks and Customer Service regarding health network enrollments.
• 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 nurse.
• Documents all contacts and case information in the system using the standard charting format.
• Performs data entry into the appropriate databases for monitoring, tracking, and trending of events, and other relevant databases as needed.
• Completes other projects and duties as assigned.

Possesses the Ability To:

• Explain and obtain relevant required data from members and providers to record and summarize findings.
• Communicate clearly and concisely, both orally and in writing.
• Establish and maintain effective working relationships with leadership and staff.
• Use prior authorization protocols to determine when to refer matters to a licensed staff person.
• Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) 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 healthcare 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

• Bilingual in English and in one of our defined threshold language (English, Spanish, Vietnamese, Farsi, Arabic, Korean, and Chinese) preferred.
• Prior Authorization and Utilization Management process knowledge preferred.

Knowledge of:

• Medical Terminology.
• Medi-Cal and Medicare benefits and regulations.
• Current ICD 10- CPT, and Healthcare Common Procedure Coding System (HCPCS) Coding continual updates to knowledge base regarding the codes.

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 status.

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