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Career Opportunities: Authorization Assistant I (24452) Requisition ID 24452 - Posted 07/25/2024 - CareOregon - Full Time - Permanent - Portland - Multi Location (9) Job Description Print Preview Candidates hired for remote positions must reside in Oregon, Washington, Utah, Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin. Job Title Authorization Assistant I Department Clinical Operations Exemption Status Non-Exempt Requisition # 24452 Direct Reports N/A Manager Title Health Related Services Manager Pay & Benefits Estimated hiring range $46,540 - $56,880 /year, 5% bonus target, full benefits. www.careoregon.org/about-us/careers/benefits Posting Notes This role is fully remote but must reside in one of the listed 9 states. Job Summary 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. 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)