Medical Authorization Rep
APR Consulting, Inc. has been engaged to identify a Medical Authorization Rep
Location: Santa Barbara, CA 93111
Position: Medical Authorization Rep
Pay Rate: $24.40/hr
Duration: 26 weeks
Expected Shift: 40 hrs/week
9am – 5pm
SUMMARY
Processes referral requests for patients to achieve timely and accurate determinations. Works within scope of practice to complete or forward requests as appropriate to Managed Care physicians and/or nurses as per the Utilization Management (UM) protocols. Maintains required turnaround times for referral completion. Assists providers and patients with referral status questions. Participates in development and implementation of improvements to the referral process and workflows.
These Principal Accountabilities, Requirements and Qualifications are not exhaustive, but are merely the most descriptive of the current job. Management reserves the right to revise the job description or require that other tasks be performed when the circumstances of the job change (for example, emergencies, staff changes, workload, or technical development).
JOB ACCOUNTABILITIES:
Processes referrals per standard work and refer others to nurses and/or MDs as necessary.
Maintains accuracy with attention to detail in each referral.
Monitors daily “pending” referrals to ensure timeliness standards are met and customer service is maximized.
Reports anticipated problems to Supervisor and/or other stakeholders.
Documents updated status in referrals per standard work.
Provides necessary medical information to obtain final determinations when required.
Processes referrals per health plan contracts and requirements.
Documents determinations in referral as per standard work.
EDUCATION: HS Diploma or equivalent education/experience
SKILLS AND KNOWLEDGE: Medical terminology, Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS)/International Classification of Diseases (ICD)-9 coding knowledge. Competency in using MS Office Excel and Word, other Managed Care programs. Ability to identify, understand and solve problems related to claims and referrals. Communication skills, including understanding of medical concepts, ability to organize thoughts, and communicate issues concisely and effectively. Proven ability to quickly adjust to changing projects and priorities and to multi-task. O
Our client is the one of the largest Healthcare Staffing Provider in the United States, to be assigned at one of their affiliated hospitals/healthcare facilities.
This particular client is requiring that all new hires show proof of vaccination. However, accommodations may be made for those with disabilities or religious reasons who cannot obtain a vaccine.
Since 1980 APR Consulting, Inc. has provided professional recruiting and contingent workforce solutions to a diverse mix of clients, industries, and skill sets nationwide.
We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by law.
Don't miss out on this amazing opportunity! If you feel your experience is a match for this position please apply today and join our team. We look forward to working with you!
APR Consulting, Inc., is one of the most trusted talent acquisition and workforce solutions providers in the United States. Known for exceptional responsiveness, agile strategies, and consistently high-level talent, the firm has become a go-to for organizations and managed services providers navigating complex change and urgent challenges. Since its founding in 1980, APR has transformed from a California IT-focused staffing firm to a full-service solutions provider filling a wide range of positions and serving over eight industries — including aerospace and defense, healthcare, IT, telecom, hospitality/gaming, sports/entertainment, government, and utilities –– in all 50 states, with a loyal roster of more than 850 specialized professionals.