Authorization Assistant I - Temporary

CareOregon • Portland, OR

2d • $23 - $28 • Remote

About The Position

The Authorization Assistant I provides technical and clerical support for one assigned focus area, such as physical health, behavioral health, health-related services, durable medical equipment, Medicare, or Medicaid. The position receives support requests from members, providers, vendors, brokers, and internal customers. The role follows departmental processes and applicable federal and state rules, regulations, and contractual requirements.

The position verifies eligibility, insurers, providers, codes, and benefits; processes authorization requests; communicates with requestors and other parties; and maintains accurate, complete documentation and notifications. It also supports customers, contributes to departmental goals and process improvements, and may cross-train or assist with duties outside its assigned focus area. Work from home in an indoor office environment, with telephonic member-facing communication.

Requirements

• At least 1 year of experience providing technical, clerical, or administrative support; qualifying customer service roles include support experience of this kind.
• Awareness of Oregon Health Plan (OHP) and Medicare A and B benefit packages.
• Ability to consistently meet production and high-quality standards.
• Ability and willingness to cross-train as needed.
• Strong computer application skills in Microsoft Office, including Word and Outlook.
• Ability to learn business applications.
• Fast and accurate data entry, attention to detail, and accuracy.
• Good organizational skills and growing ability to manage multiple tasks, prioritize, and process a high volume of work.
• Ability to communicate effectively verbally and in writing and provide good customer service.
• Flexibility, adaptability, good judgment, personal initiative, and discretion.
• Ability to work autonomously with a moderate level of supervision and effectively with diverse individuals and groups.
• Ability to learn, focus, understand, and evaluate information and determine appropriate actions.
• Ability to accept direction and feedback and tolerate and manage stress.
• Ability to see, read, and perform repetitive finger and wrist movements for at least 6 hours per day.
• Ability to hear and speak clearly for at least 3–6 hours per day.

Nice To Haves

• Experience working with electronic medical records.
• Experience processing Medicare, Medicaid, or commercial plan authorization requests.
• Experience working with coding and medical terminology.
• Basic knowledge of medical terminology, ICD-10, and CPT coding is helpful.

Responsibilities

• Support one assigned focus area and assist with complex work to the extent capable.
• Verify member eligibility and identify the primary insurer.
• Verify network providers and confirm that non-network providers are loaded into QNXT.
• Verify codes and benefits, including benefit limits, for the applicable line of business.
• Communicate with members, providers, and business associates as required to complete requests and in accordance with state and federal requirements.
• Place and receive phone calls as necessary.
• Obtain additional information from requestors or other providers in accordance with department processes.
• Process requests based on the member’s primary or secondary insurance according to department policies, procedures, and timelines.
• Respond to inquiries in a timely manner and consistently meet production and quality standards.
• Document information received and actions taken according to department standards.
• Organize and review completed request documents to ensure information is accurate, complete, and consistent with established protocols and naming conventions.
• Create member or provider notifications based on request outcomes.
• Act as a resource to internal and external customers regarding authorization requests.
• Maintain confidentiality and comply with HIPAA requirements.
• Contribute to Clinical Operations department goals and participate in cross-departmental workgroups as needed.
• Learn to fix report errors and serve as a tester for system updates or implementations as needed.
• Suggest improvements to processing guides and participate in job shadowing as needed.
• Cross-train and perform duties outside the assigned focus area as needed.
• Process retroactive authorization requests, determine whether claims were denied, and notify the claims department to reprocess appropriate claims when applicable.
• 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 procedures are followed and federal compliance standards are met.
• Review census reports daily to ensure timely review.

Benefits

• Competitive pay and bonus opportunity.
• Medical, dental, vision, life, AD&D, and disability insurance for eligible employees.
• Health savings account, flexible spending accounts, and lifestyle spending account.
• Employee assistance program, wellness program, discounts, and supplemental benefits.
• Retirement plan with employer contributions.
• PTO and Paid State Sick Time for benefits-eligible employees, accrued based on hours worked or scheduled hours and primary work state.
• Depending on eligibility, paid holidays, volunteer time, jury duty, bereavement leave, and other leave.
• For non-benefits-eligible employees: 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed