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CareOregon · 7 hours ago

Authorization Assistant I-Temporary

United States

Full-time

Remote

Entry Level

$22.82/hr - $27.89/hr

1+ years exp

CareOregon is a healthcare organization looking for a Temporary Authorization Assistant I to provide technical and clerical support in various focus areas including physical and behavioral health. The role involves verifying member eligibility, processing requests, and ensuring compliance with departmental and federal regulations.

Health Care

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

Qualification

Medicare processingMedicaid processingElectronic medical recordsICD10 codingCPT codingData entryCustomer serviceOrganizational skillsCommunication skillsAttention to detailFlexibility

Required

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

Preferred

Experience working with electronic medical records

Experience processing Medicare, Medicaid, or commercial plan authorization requests

Experience working with coding and medical terminology

Benefits

Medical

Dental

Vision

Life

AD&D

Disability insurance

Health savings account

Flexible spending account(s)

Lifestyle spending account

Employee assistance program

Wellness program

Discounts

Multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.)

Strong retirement plan with employer contributions

PTO

Paid State Sick Time

Paid holidays

Volunteer time

Jury duty

Bereavement leave