Authorization Assistant

CareOregon•Portland, OR

4d•$23 - $28•Remote

About The Position

The Authorization Assistant I provides technical 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. This is a temporary, benefit‑eligible position with an expected duration of approximately 6 months. We are looking for candidates that reside in the Portland Metro area. Estimated Hiring Range: $22.82 - $27.89 Bonus Target: Bonus - SIP Target, 5% Annual Current CareOregon Employees: Please use the internal Workday site to submit an application for this job.

Requirements

Minimum 1 year experience providing technical, clerical, or administrative support (includes customer service roles that provide technical, clerical, or administrative support)
Awareness of the Oregon Health Plan (OHP) and Medicare A & B benefit packages
Basic knowledge of medical terminology, ICD10, and CPT coding helpful
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

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

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