Partnership HealthPlan of California · 1 month ago
Authorization Specialist/ UM Trainer
US-CA-Fairfield
Full-time
Onsite
Entry Level
$34.79/hr - $43.48/hr
1+ years expPartnership HealthPlan of California is seeking an Authorization Specialist/UM Trainer to support the processing of Treatment Authorization Requests (TARs) and provide training for new hires and ongoing education for staff. The role involves maintaining training materials, collaborating with leadership on staff enhancement trainings, and ensuring the successful implementation of departmental software systems.
Health CareInsuranceNon Profit
Responsibilities
To process TARs for selected services using specific procedures and protocol and to provide administrative assistance to UM Coordinators and Leadership staff as assigned
Serves as Systems Trainer for all new hires and provides ongoing education for all HS/UM staff
Prepares and maintains up-to-date training and educational materials for new and existing staff
Provides hands-on training during new hire orientation
Collaborates in the on-going trainings for staff education of latest department changes and updates, which includes but is not limited to NCQA standards, Whole Child Model and Essette
Develop and distribute supporting material
Works closely with UM leadership to produce staff enhancement trainings, which includes development of the agenda, preparing materials and handouts, presenting the training in conjunction with leadership presenters
Provides training not only to the designated department HS/UM but also HS/CC and internal Partnership’s departments that require support and knowledge of UM’s program and TAR process
Monitors and has full proprietorship of the UM Departments Help Desk, which includes assessing inquiries, and either resolving or escalating to appropriate staff as needed
Supports the successful implementation of the UM Department’s software systems and online services, proceeding the participation of a testing environment
Processes Treatment Authorization Requests (TARs) pertaining to wheelchairs, diabetic shoes, nebulizers, dialysis, and Hospice services, etc
Assists in determining appropriateness, quality and medical necessity for all specialty related medical equipment for pediatrics open to Whole Child Model, and necessity of DME for children enrolled with a County MTU Clinic
Works with appropriate consultants to facilitate the need for an in-home assessment to determine the medical necessity of DME equipment
Assists network providers and other departments with issues concerning TARs
Acts as a resource regarding UM department computer programs and special projects upon request
Verifies member’s eligibility and designated program benefits
Elicits medical information from provider, consulting with HS/UM clinical staff as appropriate
Monitors consultant’s turnaround time and initiates follow-up as necessary
Prepares Medical Director work sheet for review by Chief Medical Officer (CMO) or physician designee as appropriate
If not approved by consultant, reassigns TAR to UM Clinical Coordinator for processing
Provides overflow support to both Data Coordinators and Nurse Coordinators
Participates in special projects and assignments as required
Assists in the refinement/improvement of the UM Department by participating in continuous process improvement endeavors
Other duties as assigned
Qualification
Required
Certified Medical Assistant or minimum one (1) year experience in the medical/clerical field; or equivalent combination of education and experience
Ability to work within an interdisciplinary team structure and function in a fast-paced environment while managing multiple priorities and meeting deadlines
Strong organizational skills required
Effective telephone and computer data entry skills required
Ability to access data and information using automated systems
Valid California driver's license and proof of current automobile insurance compliant with Partnership policy are required to operate a vehicle and travel for company business
Excellent written and verbal communication skills
Ability to follow established procedures and protocol
Ability to communicate effectively with coworkers, physicians, and health care providers
Daily use of telephone and computer for most of the day
Ability to use a computer keyboard
Must be able to lift, move, or carry objects of varying size, weighing up to 10 lbs
Preferred
General knowledge of managed care with emphasis in UM preferred
Company
Partnership HealthPlan of California
Partnership HealthPlan of California is a non-profit community-based health care organization that contracts with the state to administer Medi-Cal benefits through local care providers to ensure Medi-Cal recipients have access to high-quality comprehensive cost-effective health care.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
L
Lorna Veloso
Sr. Manager of OpEx/PMO
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