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Libertana · 1 day ago

Cal-Aim Authorization Coordinator

Los Angeles, CA

Full-time

Hybrid

Entry Level

$24/hr - $25/hr

2+ years exp

Libertana is seeking a Transitions Cal AIM Authorization Coordinator to manage the intake of new members and process billing and authorizations. The role involves supporting various administrative functions for the CalAim departments and ensuring compliance with contract expectations.

Elder CareFranchiseHealth Care

Responsibilities

Tracks and ensures referrals are processed within the time frames stated in the CalAim/CCT contract expectations

Fields incoming calls and makes outgoing calls to all potential new members

Reviews and compiles intake documents to ensure paperwork is properly completed and submitted to Health Plans for authorization

Tracks and update authorization status for new members

Performs eligibility screener in compliance with CalAim/CCT policies and procedures

Works with other departments to identify gaps in care for members and generate internal referrals

Uses the different Managed Care Provider (MCP’s) portals to submit initial authorization and reauthorizations requests for all CalAim services

Has a clear understanding of services provided under CalAim (ECM and CS) and CCT with the ability to clearly communicate them to potential members

Creates patient charts and uploads referral and authorization documentation into the EMR system

Processes approved authorizations and coordinates follow up activities for Case Managers

Provides updates to external care partners regarding patient status and/or other relevant information

Completes CCT, CS, ECM visit logs and works through integration logs as needed

Assists with completing DHCS CCT forms (ITCP, FTCP, DTRF) based on the RN assessment

Assists in completing weekly and monthly CalAim MCP reports on CS Communications Log, CS Return Transmission File (RTF) and ECM Return Transmission File (RTF) & ECM Outreach Transmission File (OTF)

Conforms to all agency policies and procedures

Maintains/conserves confidentiality of patient and agency information always with HIPAA regulations

Regularly attends and participates in scheduled case conferences, staff meetings and agency in-services. (in person, by phone or on the web)

Follows policies and procedures as per Employee Handbook

Maintains all required credentials up to date

Reports Fraud and Abuse

Knowledge of mandated reporting

Conducts timely recording and/or documentation of client contact

Performs other duties as assigned

Qualification

Healthcare AdministrationElectronic healthcare systemsMicrosoft WordMicrosoft ExcelReport developmentPhone etiquetteFollow up skillsCommunication skillsOrganizational skills