Authorization Specialist II (LPHA)

Tarzana•Los Angeles, CA

50d

About The Position

Under the general supervision of the Quality Assurance Supervisor, the Authorization Specialist II focuses on managing contract patient authorization status issues. This position is also responsible for reporting on relevant measures and suggesting and coordinating improvement activities when directed. We offer a competitive benefits package: Medical Insurance Dental Insurance Vision Care Plan Life Insurance Paid Holidays (12) Paid Vacation Time Sick Time 401(k) Retirement Plan Competitive wages Stability and career advancement Continuing Education Opportunities HOURS 40 per week, Monday-Friday

Requirements

Master's level degree or higher with at least three years of work experience.
Must be a License-Eligible Practitioner of the Healing Arts (LPHA).
Prior experience in auditing and/or quality assurance in a healthcare setting.

Nice To Haves

Knowledge of Los Angeles Department of Public Health, authorization processes preferred.
Knowledge and experience with SAGE and Avatar preferred.

Responsibilities

Reviews ASAM assessments and relevant items to determine appropriate patient authorization needs.
Applies for initial authorizations and re-authorizations with SAPC for all levels of care as clinical contact.
Communicates with programs to provide Treatment Plan Update upon SAPC request and correspond with SAPC regarding ongoing authorizations as needed.
Reviews appropriate reports for authorization updates and communicates with programs about authorization status, as necessary.
Requests program transfers and discharges to align with authorizations, as necessary.
Inputs information into EHR systems as required for authorization needs. Communicates that information to the programs as needed.
Reviews and reconciles denied authorizations from County funding sources and communicates with program staff to reverse denials to maximize revenue for the Drug Medi- Cal contract.
Works to automate the review, processing and reporting of authorizations throughout the organization.
Assist programs with clinical reviews for grievances and appeals as needed.
Acts as an expert on the authorization process for the organization.
Works with program staff to review admission and other relevant workflows to improve authorization process and increase approvals.
Attends training on authorization processes and communicates findings throughout the organization, as necessary.
Performs other related duties as assigned by CEO, Director of Information Technology or QA Supervisor.