Candidates hired for remote positions must reside in Oregon, Washington, Utah, Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin.
Authorization Assistant I
Director, Clinical Operations
Estimated hiring range $46,540 - $56,880/year, 5% bonus target, full benefits.
www.careoregon.org/about-us/careers/benefits
This role is fully remote but must reside in one of the listed 9 states.
Job Summary
The Authorization Assistant I provides ttechnical and clerical support related to one (1) assigned focus area (functional area or line of business). Focus areas include physical health, behavioral health, health-related services, durable medical equipment, Medicare, Medicaid and/or other areas. The position receives requests for support from members, providers, vendors, and brokers as well as internal customers. In all communications and job duties, the role is responsible for adhering to departmental processes, federal and state rules and regulations, and contractual regulatory requirements.
Essential Responsibilities
- Responsible for supporting (1) focus areas.
- Assist with complex work to the extent capable.
- Verify member eligibility and determine the primary insurer.
- Verify network providers.
- Verify non-network providers are loaded into QNXT.
- Verify codes and benefits, including benefit limits, based on the applicable line of business (e.g., Medicare, Medicaid, etc.).
- Communicate with members, providers, and all business associates in accordance with state and federal requirements as needed to complete requests.
- Communicate via the phone (placing and receiving phone calls) as necessary.
- Obtain additional information as needed from the requestor or other providers in accordance with department processes.
- Process requests based on the members primary or secondary insurance as appropriate in accordance with department policies, procedures, and timelines.
- Respond to inquiries in a timely manner.
- Responsible for consistently meeting production and quality standards.
- Document information received and action taken according to the department’s documentation standards.
- Upon the completion of requests, organize and review documents to ensure all required information is accurate and complete in the system and in accordance with established protocols.
- Ensure naming conventions are consistent across all platforms and in accordance with department documentation requirements.
- Create appropriate member/provider notification based on request outcome.
- Act as a resource to both internal and external customers regarding authorization requests.
- Maintain confidentiality and adhere to HIPAA requirements.
- Contribute to the Clinical Operations department effort to reach goals.
- Participate in cross-departmental workgroups as needed.
- Learn how to fix report errors.
- Serve as a tester for system updates and/or implementations as needed.
- Contribute suggestions to improve processing guides.
- Participate in job shadowing as needed.
- Cross-train and attend to duties outside of focus area as needed:
- Process retroactive authorization requests for approvals and determine if claim was denied, and if so, notify claims department to reprocess appropriate claim(s)
- Notify providers of admission and discharge dates
- Research and resolve questions related to hospitalizations or other facility admissions and discharges
- Work with clinical staff to ensure length of stay follows required procedures and meets federal compliance standards
- Review census reports daily to ensure timely review is conducted
Organizational Responsibilities
- Perform work in alignment with the organization’s mission, vision and values.
- Support the organization’s commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals.
- Strive to meet annual business goals in support of the organization’s strategic goals.
- Adhere to the organization’s policies, procedures and other relevant compliance needs.
- Perform other duties as needed.
Experience and/or Education
Required
- Minimum 1 year experience providing technical, clerical, or administrative support (includes customer service roles that provide technical, clerical, or administrative support)
Preferred
- Experience working with electronic medical records
- Experience processing Medicare, Medicaid, or commercial plan authorization requests
- Experience working with coding and medical terminology
Knowledge, Skills and Abilities Required
Knowledge
- Awareness of the Oregon Health Plan (OHP) and Medicare A & B benefit packages
- Basic knowledge of medical terminology, ICD10, and CPT coding helpful
Skills and Abilities
- Ability to consistently meet production standards
- Ability to consistently meet high quality standards
- Ability to and willingness to cross-train as needed
- Strong computer application skills in MS Office including Word, and Outlook
- Ability to learn business applications
- Fast and accurate data entry
- Ability to attend to detail and accuracy
- Good organizational skills
- Growing ability to effectively manage multiple tasks, prioritize and process a high volume of work
- Communicate effectively, both verbally and in writing
- Good customer service skills
- Ability to be flexible and adaptable
- Ability to use good judgment, personal initiative, and discretion to perform job responsibilities
- Ability to work autonomously with moderate level of supervision
- Ability to work effectively with diverse individuals and groups
- Ability to learn, focus, understand, and evaluate information and determine appropriate actions
- Ability to accept direction and feedback, as well as tolerate and manage stress
- Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day
- Ability to hear and speak clearly for at least 3-6 hours/day
Working Conditions
Work Environment(s): Indoor/Office Community Facilities/Security Outdoor Exposure
Member/Patient Facing: No Telephonic In Person
Hazards: May include, but not limited to, physical and ergonomic hazards.
Equipment: General office equipment
Travel: May include occasional required or optional travel outside of the workplace; the employee’s personal vehicle, local transit or other means of transportation may be used.
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Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment.
Veterans are strongly encouraged to apply.
We are an equal opportunity employer. CareOregon considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or veteran status.
Visa sponsorship is not available at this time.
