[Remote] Authorization Assistant I-Temporary

Note: The job is a remote job and is open to candidates in USA. CareOregon is a healthcare organization seeking a Temporary Authorization Assistant I to provide technical and clerical support in various functional areas. The role involves verifying member eligibility, processing requests, and ensuring compliance with state and federal regulations.

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

Skills

• 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
• 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, and 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 and Paid State Sick Time
• Paid holidays
• Volunteer time
• Jury duty
• Bereavement leave

Company Overview