Transitions Authorization Coordinator

Job Description

Job Description

Job Description

Position: Transitions Authorization Coordinator

Pay Range: $24-27 hourly

Reporting To: Authorization Team Supervisor

Work Type: Hybrid

POSITION SUMMARY:

The Transitions Authorization Coordinator is responsible for managing the intake of new members, processing billing and authorizations, and supporting various administrative functions for the CalAim and CCT departments.

QUALIFICATIONS:

1. Bachelor's degree in Healthcare Administration, Business Administration or related field preferred.
2. Has adequate computer experience in Microsoft Word and Excel.
3. 2+ years of Administration experience.
4. Is at least 18 years of age.
5. Excellent communication skills and ability to engage others.
6. Proper phone etiquette.
7. Experience in working with electronic healthcare systems.
8. Experience with developing reports.
9. Strong organizational and follow up skills

ESSENTIAL DUTIES AND RESPONSIBILITIES:

The following is a representation of the major duties and responsibilities of this position. The agency will make reasonable accommodations to allow otherwise qualified applicants with disabilities to perform essential functions.

1. Tracks and ensures referrals are processed within the time frames stated in the CalAim/CCT contract expectations.
2. Fields incoming calls and makes outgoing calls to all potential members.
3. Reviews and compiles intake documents to ensure paperwork is properly completed and submitted to Health Plans for authorization
4. Tracks and update authorization status for new members.
5. Performs eligibility screener in compliance with CalAim/CCT policies and procedures.
6. Works with other departments to identify gaps in care for members and generate internal referrals.
7. Uses the different Managed Care Provider (MCP’s) portals to submit authorization and reauthorizations requests for all CalAim services.
8. Has a clear understanding of services provided under CalAim (ECM and CS) and CCT with the ability to clearly communicate them to potential members.
9. Creates patient charts and uploads referral and authorization documentation into the EMR system.
10. Processes approved authorizations and coordinates follow up activities for Case Managers
11. Provides updates to external care partners regarding patient status and/or other relevant information.
12. Completes CCT, CS, ECM visit logs and works through integration logs as needed.
13. Assists with completing DHCS CCT forms (ITCP, FTCP, DTRF) based on the RN assessment.
14. 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).
15. Conforms to all agency policies and procedures.
16. Maintains/conserves confidentiality of patient and agency information always with HIPAA regulations.
17. Regularly attends and participates in scheduled case conferences, staff meetings and agency in-services.
18. Follows policies and procedures as per Employee Handbook.
19. Maintains all required credentials up to date.
20. Reports Fraud and Abuse.
21. Knowledge of mandated reporting.
22. Conducts timely recording and/or documentation of client contact.
23. Attends Department meetings (in person, by phone or on the web).
24. Attends all State mandated in-service training.
25. Performs other duties as assigned.

PHYSICAL REQUIREMENTS:

1. Stand, sit, talk, hear, reach, stoop, kneel and use of hands and fingers to operate computer, telephone, and keyboard on a frequent basis, up to 75% of the time.
2. Close vision requirements due to computer work.
3. Light to moderate lifting may be required up to 25lbs.