Prior Auth Coordinator

Lakeside Medical Northridge, CA
As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.

We currently have an openings for a Prior Authorization Coordinator:

The role of the Prior Auth Coordinator is to promptly, efficiently and accurately execute all aspects of the referral process. Promote the quality and cost effectiveness of medical care through strict adherence to all UM Policy and procedure.

1. Anticipate our customer needs: Understand the wants and needs of customers, listen for cues and identify how to respond and what level of intervention they need

2. Understand and execute the principles of UM to facilitate the right care at the right time in the right setting.

3. Communicate effectively and interact with the provider group and health plans daily or as indicated regarding UM and referral authorization issues.

4. Data entry via GCEA/REA

5. Process request that are approved, denied or deferred and bring them to resolution.

6. Responsible for Deferred authorization maintenance, tracking and follow up.

7. Responsible for the EIOD process, including log maintenance; and patient notifications

8. Checks eligibility and benefits on all DME and home health authorizations prior to forwarding on request to prior authorization nurse or medical director for approval.

9. Returns phone calls to customers and follows up with requests.

10. Maintain turnaround time compliance in all aspects of the UM process.

11. Maintain all reference material that is provided by the supervisor, manager or director.

12. Know and follow the Employee Handbook policies and procedures.

13. Maintain patient confidentiality so that HIPAA compliance is observed at all times.

14. Demonstrates honesty and integrity in everyday activities.

15. Recognizes when an error has been made and immediately reports to appropriate manager.

16. Maintain regulatory Turn Around Time Standards per CMS (Seniors) and ICE (Commercial).

17. Maintains quality monitors as assigned by Supervisor.

18. Assists other staff and supports the team approach.

19. Participates in the efficient, effective, and responsible use of resources such as supplies and equipment.

20. Communicates appropriately and clearly to management, co-workers, and physicians.

21. Other Duties as assigned

We offer a full benefits package which includes employer paid medical, pharmacy and dental benefits. We offer a generous PTO package, 401k Retirement Savings, Life Insurance, Flexible Spending Account (FSA), Tuition Reimbursement & Licensed Renewal Fees for our clinical staff.

Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.

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