WHO WE ARE: AMAZING INDIVIDUALS WORKING FOR POSITIVE PEOPLE at AIDS Healthcare FoundationDoes the idea of doing something that really makes a difference in peoples lives while being well-compensated intrigue you?
Are you looking to work for an organization that encourages growth and success from each and every one of its employees?If so, AIDS Healthcare Foundation is the place for youFounded in 1987, AIDS Healthcare Foundation is the largest specialized provider of HIV/AIDS medical care in the nation.
Our mission is to provide cutting edge medicine and advocacy, regardless of ability to pay.
Through our healthcare centers, pharmacies, health plan, research and other activities, AHF provides access to the latest HIV treatments for all who need them.AHFs core values are: Patient-Centered Value Employees Respect for Diversity Nimble Fight for Whats RightSTILL INTERESTED?
Please continue YOUR CONTRIBUTION TO OUR SUCCESS: Position Overview: Under the direction of the Manager, the Authorization Coordinator is responsible for projecting and integrating the Mission and Core Values of the AIDS Healthcare Foundation (AHF) in the provision of quality specialty services to members of the PHP and PHC Medicare and Medi-Cal HMO Product Lines.
The Authorization Coordinator is responsible for applying the policies, processes and Medicare Local and National Coverage determinations in the provision of services to members of the health plan.
Essential Duties & ResponsibilitiesIncludes the following.
Other duties may be assigned.Develops and maintains current knowledge of the PHP & PHC Plans program policies, procedures and serviceAnswers questions and educates referring providers on the processes, requirements and documentation required to authorize services that promote quality of care.Processes Specialty Referral Forms; checks Specialty Referral Forms for accuracy and completeness assures all necessary clinical data required for the referral isEnters required data into authorization software accurately andReviews and monitors Specialty Referrals in Secured Fax logs or designated database; monitors status of referral to ensure timelyAdheres to contract measure per product line processing of all routine authorizations within 14 calendar days for Medicare, 5 Calendar Days for Medi-Cal and 72 hours for all incoming request marked urgent, expedited, STAT or ASAP.Reports to Manager any referrals that have not met the required timeline and monitors daily reports of completed authorizations for quality assuranceContact patient by telephone to inform that referral has been approved or denied and logs the event appropriately within the authorization system.
When required on expedited authorizations, also verbally contacts the requesting provider of the approval or denial.