Transitions Authorization Coordinator
Transitions Authorization Coordinator
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$ 24 - 27
1 Vacancy
Job Description
Job Description
Position: Transitions Authorization Coordinator
Pay Range: $24-27 hourly
Reporting To: Authorization Team Supervisor
Work Type: Hybrid
POSITION SUMMARY:
The Transitions Authorization Coordinator is responsible for managing the intake of new members processing billing and authorizations and supporting various administrative functions for the CalAim and CCT departments.
QUALIFICATIONS:
- Bachelors degree in Healthcare Administration Business Administration or related field preferred.
- Has adequate computer experience in Microsoft Word and Excel.
- 2 years of Administration experience.
- Is at least 18 years of age.
- Excellent communication skills and ability to engage others.
- Proper phone etiquette.
- Experience in working with electronic healthcare systems.
- Experience with developing reports.
- Strong organizational and follow up skills
ESSENTIAL DUTIES AND RESPONSIBILITIES:
The following is a representation of the major duties and responsibilities of this position. The agency will make reasonable accommodations to allow otherwise qualified applicants with disabilities to perform essential functions.
- Tracks and ensures referrals are processed within the time frames stated in the CalAim/CCT contract expectations.
- Fields incoming calls and makes outgoing calls to all potential members.
- Reviews and compiles intake documents to ensure paperwork is properly completed and submitted to Health Plans for authorization
- Tracks and update authorization status for new members.
- Performs eligibility screener in compliance with CalAim/CCT policies and procedures.
- Works with other departments to identify gaps in care for members and generate internal referrals.
- Uses the different Managed Care Provider (MCPs) portals to submit authorization and reauthorizations requests for all CalAim services.
- Has a clear understanding of services provided under CalAim (ECM and CS) and CCT with the ability to clearly communicate them to potential members.
- Creates patient charts and uploads referral and authorization documentation into the EMR system.
- Processes approved authorizations and coordinates follow up activities for Case Managers
- Provides updates to external care partners regarding patient status and/or other relevant information.
- Completes CCT CS ECM visit logs and works through integration logs as needed.
- Assists with completing DHCS CCT forms (ITCP FTCP DTRF) based on the RN assessment.
- Assists in completing weekly and monthly CalAim MCP reports on CS Communications Log CS Return Transmission File (RTF) and ECM Return Transmission File (RTF) & ECM Outreach Transmission File (OTF).
- Conforms to all agency policies and procedures.
- Maintains/conserves confidentiality of patient and agency information always with HIPAA regulations.
- Regularly attends and participates in scheduled case conferences staff meetings and agency in-services.
- Follows policies and procedures as per Employee Handbook.
- Maintains all required credentials up to date.
- Reports Fraud and Abuse.
- Knowledge of mandated reporting.
- Conducts timely recording and/or documentation of client contact.
- Attends Department meetings (in person by phone or on the web).
- Attends all State mandated in-service training.
- Performs other duties as assigned.
PHYSICAL REQUIREMENTS:
- Stand sit talk hear reach stoop kneel and use of hands and fingers to operate computer telephone and keyboard on a frequent basis up to 75% of the time.
- Close vision requirements due to computer work.
- Light to moderate lifting may be required up to 25lbs.
Required Experience:
IC
Employment Type
Full Time
