Established in 1997, L.A.
Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents.
We are the nation’s largest publicly operated health plan.
Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time.Mission: L.A.
Care’s mission is to provide access to quality health care for Los Angeles County’s vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.Job SummaryThe Authorization Technician II supports the Utilization Management (UM) Specialist by handling all administrative and technical functions of the authorization process including intake, logging, tracking and status follow-up.The Authorization Technician II collects information required by clinical staff to render decisions, assists the Manager and Director of the Utilization Management department in meeting regulatory time lines by maintaining an accurate database inventory of referral authorizations, retrospective reviews, concurrent reviews and grievance/appeal requests, and prepares UM Activity and Weekly Compliance addition, the position performs data entry and processing of referrals/authorizations in the system, authorizes request consistent with auto authorization criteria, maintains confidentiality when communicating member information, and assists with the communication of determinations by preparing template letters for members/ providers, with other duties as assigned.DutiesFunctional Elements: Technical Support to UM Specialist: Processing of time sensitive authorization and pre-certification requests to meet department timeframes and regulatory requirements; Computer Input: Accurately and completely processing referrals/authorizations in the MHC system and distributing a complete file to UM Specialist within 2 hours of receipt; Identify duplicate requests using the claims and CSIM system to verify existing authorization.
Independently identifying and appropriately returning to claims or member services any file that is a duplicate to one already processed in the system; Appropriately documenting what information was used in making this determination within 4 hours of receipt.
Appropriate identification and timely notification of time sensitive requests; Appropriately identifying for the staff which you support, request that are priority based on date of receipt and established TAT criteria for compliance.
Accurate Filing/Maintenance of confidential member information.
Creating secure, complete, files.
Interface with members, medical personnel and other internal and external agencies; Ensure that all comply with L.A.
Care requirements such as submitting requested information in a timely manner and using the approved Authorization Request form with complete medical information i.e.: DX codes, CPT, HCPC codes.
(35%)Assist in the preparation of communication for authorization determinations, including, but not limited to preparing template letters for members and providers (authorization approval, denial, deferral, modification and pay/education).
(30%)Education RequiredHigh School Diploma/or High School Equivalency CertificateEducation PreferredExperienceRequired:At least 0-6 months of experience in Medi-Cal managed care authorization processes and/or as a Medical Assistant.SkillsRequired:Demonstrated proficiency in Medical Terminology requiredStrong verbal and written communication skills.Proficient with Microsoft Word, Excel, and Access.Excellent organizational, interpersonal and time management skills.Must be detail-oriented and an enthusiastic team player.Preferred:Knowledge of MHC and/or CSIIM computer systems a plus.Licenses/Certifications RequiredLicenses/Certifications PreferredMedical Coding CertificationRequired TrainingAdditional InformationL.A.
Care offers a wide range of benefits including Paid Time Off (PTO) Tuition Reimbursement Retirement Plans Medical, Dental and Vision Wellness Program Volunteer Time Off (VTO)At L.A.
Care, we value our team members’ safety.
In order to keep our work locations safe, each employee is required to self-screen for symptoms prior to entering any L.A.
Care location each day.
L.A.
Care and all of its staff are required to comply with all state and local masking orders.
Therefore, when on-site at any L.A.
Care location, employees are expected to wear a mask in areas where physical distancing cannot be managed.Nearest Major Market: Los AngelesJob Segment: Medical, Claims, Medical Coding, Medical Assistant, Data Entry, Healthcare, Insurance, Administrative