Position Summary
Provides assistance to CCHP Medical Management Department in all stages of authorizations, tasks, and work flows.
Major Responsibilities and Duties
1. Verifies member eligibility, enrollment, Evidence of Coverage, plan codes, and Explanation of Benefits.
2. Prepares and completes authorization forms for review.
3. Assures timely, organized processing of inpatient and outpatient authorizations for input into the core computer system.
4. Utilizes fax and telephone contacts to obtain information (clinical and non-clinical) from physicians, families and facilities and reports information to UM nurses/medical director requested.
5. Processes denials for non-coverage ensuring that the proper letterhead, template and version is used and the proper denial language is used in compliance with current regulations, policy and procedures.
6. Serves as back up to all additional Utilization Management Assistants.
7. Scans authorizations, notices of non-coverage and other UM documents for filing.
8. Complies with CCHP Compliance Handbook including Code of Ethics and all statues, regulations and guidelines applicable to federal and state programs. Responsibilities include following guidelines, reporting suspected violations of any statute complaints with regulations, agreements or guidelines applicable to all health programs or TPA programs.
9. Accepts and performs other duties as assigned.
10. Performs audits on outpatient utilization as requested.
11. Files all related authorization documents in appropriate paper or electronic folders.
12. Multitask effectively (enter authorizations, complete denial letters, filing, phone answering, reports as requested/required, correspondence letters and additional duties as assigned).
Job Requirements
High School degree requiredCollege level courses preferredMedical terminology preferredFluent in English – written and spoken. Must communicate clearly with physician office staff to explain requirements and criteria for authorization requests.Chinese speaking –Cantonese/Mandarin preferredPolite, personable & professional telephone etiquetteSkills and Abilities
Excellent English verbal and written communication skillsTyping speed of at least 50 words/minuteAbility to set and change priorities quickly and as the situation warrantsWorking knowledge of Windows 2003 and higher, Word, Excel, Access, Outlook, and a variety of printers. Basic familiarity with networked office operationsAbility to maintain high volume (minimum 40 authorizations/day) workload without compromising qualityAbility to work as a member of a team and to encourage team resolutions to problemsAbility to rapidly proofread high volume workloadEffective communication with team, management and physiciansPersonable, outgoing, reliable, dependable, team playerExcellent organizational skills, able to multitask efficientlyExperience
Minimum three years in comparable positionMinimum three year experience in health care preferred
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