Back to Jobs search

Authorization Technician II

L.A. Care Health Plan • Los Angeles, CA • 5h ago

Job Category: Administrative, HR, Business Professionals

Department: Utilization Management

Location:

Los Angeles, CA, US, 90017

Position Type: Full Time

Requisition ID: 12980

Salary Range: $47,840.00 (Min.) - $57,062.00 (Mid.) - $68,474.00 (Max.)

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, 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 Summary

The 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 Reports.

In 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.

Duties

Functional 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 and distribute a complete file to UM Specialist within 2 hours of receipt; identify duplicate requests using the claims and 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 Turnaround Time 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 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.: ICD 10 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%) Assist in the technical aspects of the retrospective review process for authorizations and Member or Provider Appeals, including, but not limited to computer data entry, logging, copying, preparing of template letters for communication of appeal determinations to members, providers and partners (appeal uphold or overturn) and filing: Set up GNA files for review, log and keep track all due dates for each file. Inform nurses of a new case received from Grievance and Appeals Specialist.; submit all Grievances and Appeals response letters to Grievances Specialist on daily basis. (20%) Support UM Committee and Audit activity via Department performance reporting. Assure the accuracy of reports concerning inventory and department proficiency in maintaining regulatory standards and time frames. (5%)

Perform other duties as assigned. (10%)

Duties Continued

Education Required

High School Diploma/or High School Equivalency Certificate

Education Preferred

Experience

Required:

At least 6 months of health care experience.

Experience working in a cross functional work environment.

Preferred:

Experience in Medi-Cal managed care.

1 year of experience in UM/Prior Authorization.

Skills

Required:

Demonstrated proficiency in Medical Terminology required.

Strong verbal and written office communication skills.

Proficient with Microsoft Office Suite and Adobe PDF. and

Excellent organizational, interpersonal and time management skills.

Must be detail-oriented and an enthusiastic team player.

Preferred:

Knowledge of QNXT computer systems a plus.

Knowledge of the UM patient referral process.

Knowledge of member's health plan eligibility.

Knowledge of member's benefits coverage.

Knowledge of Health Plan regulations.

Knowledge of HMO/UM functions.

Knowledge of ICD-10/CPT coding.

Proficient utilizing electronic medical records and documentation programs.

Licenses/Certifications Required

Licenses/Certifications Preferred

Medical Coding Certification

Required Training

Physical Requirements

Light

Additional Information

Required:

Weekends and holidays hours may be required, as well as OT based on a business need.

Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.

L.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)

Similar Jobs

Electrical Design Intern

Legence • Long Beach, CA • 8h ago

IT & Engineering

P2S stands as a provider of professional engineering services to a broad range of markets, including higher education, healthcare, ports/harbors, industrial, entertainment, commercial, laboratories, municipal, and federa...

8h ago

Go to Apply

Hvac Technician

Aerotek • Van Nuys, CA • 12h ago

IT & Engineering

Description : If you have HVAC Technician experience and you're looking for a new position ASAP , then this is the position for you. A popular HVAC company in Van Buys is looking for a HVAC Technician to join their team!...

12h ago

Go to Apply

(USA) Tire & Battery Technician - Automotive

Walmart • Glendora, CA • 17h ago

IT & Engineering

Position Summary... As a Tire & Battery Center Technician you will work to provide safe and efficient service in both the sales and service areas of the department and deliver to our members more of what they love, f...

17h ago

Go to Apply

Deburring Technician

Aerotek • Long Beach, CA • 18h ago

IT & Engineering

Job Title: Deburring Technician Job Description As a Deburring Technician, you will be responsible for grinding and deburring aerospace metal parts using hand grinders, pneumatic tools, and other bench equipment. You wil...

18h ago

Go to Apply

Platform Engineer

Robert Half • Los Angeles, CA • 18h ago

IT & Engineering

Description Robert Half is currently seeking a Platform Engineer (Azure, CI/CD, DevOps) for a reputable client located in the Los Angeles, CA area. This is a 100% REMOTE opportunity. Platform Engineer (Azure, CI/CD, DevO...

18h ago

Go to Apply

Cardiac Cath Lab - Cath Lab / Interventional Technologist

Trusted Health • Glendale, CA • 21h ago

IT & Engineering Sponsored

Trusted is seeking an experienced allied health professional for this exciting travel assignment. Trusted has streamlined the travel experience by enabling clinicians to apply directly to jobs without the need for recrui...

21h ago

Go to Apply

Senior Electrical Engineer

Abbott • Sylmar, CA • 1d ago

IT & Engineering

Abbott is a global healthcare leader that helps people live more fully at all stages of life. Our portfolio of life-changing technologies spans the spectrum of healthcare, with leading businesses and products in diagnost...

1d ago

Go to Apply

Supervisor Electrical Ops

FREEMAN • Anaheim, CA • 1d ago

IT & Engineering

About Us Freeman is a global leader in events, on a mission to redefine live for a new era. With a data-driven approach and the industry' largest network of experts, Freeman's insights shape exhibitions, exhibits, and ev...

1d ago

Go to Apply

Software Engineer - Interactive Visualization

The Walt Disney Company • Burbank, CA • 1d ago

IT & Engineering

At Walt Disney Animation Studios we have a deep commitment to the philosophy that creativity inspires technology, and technology inspires creativity. Engineers on our Production Technology team develop and implement new...

1d ago

Go to Apply

Manufacturing Engineer

The Boeing Company • Sylmar, CA • 1d ago

IT & Engineering

Job Description At Boeing, we innovate and collaborate to make the world a better place. We're committed to fostering an environment for every teammate that's welcoming, respectful and inclusive, with great opportunity f...

1d ago

Go to Apply

Subscribe to get new jobs sent directly to you
(no charge, cancel anytime)

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.