Authorization Assistant 1

Authorization Assistant I - Temporary

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The Authorization Assistant I provides technical and clerical support related to one (1) assigned focus area (functional area or line of business). Focus areas include physical health, behavioral health, health-related services, durable medical equipment, Medicare, Medicaid and/or other areas. The position receives requests for support from members, providers, vendors, and brokers as well as internal customers. In all communications and job duties, the role is responsible for adhering to departmental processes, federal and state rules and regulations, and contractual regulatory requirements.

Estimated Hiring Range:

$23.28 - $28.45

Bonus Target:

Bonus - SIP Target, 5% Annual

Priority will be given to candidates residing in Oregon and Southwest Washington.

Current CareOregon Employees: Please use the internal Workday site to submit an application for this job.

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Essential 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

Experience and/or Education

Required

• Minimum 1 year experience providing technical, clerical, or administrative support (includes customer service roles that provide technical, clerical, or administrative support)

Preferred

• Experience working with electronic medical records
• Experience processing Medicare, Medicaid, or commercial plan authorization requests 
• Experience working with coding and medical terminology  

Knowledge, Skills and Abilities Required

Knowledge

• Awareness of the Oregon Health Plan (OHP) and Medicare A & B benefit packages  
• Basic knowledge of medical terminology, ICD10, and CPT coding helpful 

Skills and Abilities

• 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 

Working Conditions

Work Environment(s):         ☒ Indoor/Office    ☐ Community      ☐ Facilities/Security                       ☐ Outdoor Exposure

Member/Patient Facing:     ☐ No                        ☒ Telephonic       ☐ In Person

Hazards:  May include, but not limited to, physical and ergonomic hazards.

Equipment:  General office equipment

Travel:  May include occasional required or optional travel outside of the workplace; the employee’s personal vehicle, local transit or other means of transportation may be used.

Work Location: Work from home

We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package.  Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information.

We are an equal opportunity employer

CareOregon is an equal opportunity employer.  The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.