Job Description

For more details, please connect with Ibad Khan at 971-431-1753 or email at ibadk@vgroupinc.com

Client: Healthcare

Job Title: Medical Biller/ Coder/ Authorization Assistant

Duration: 06 Months

Start Date: ASAP

Location: 505 City Parkway West, Orange CA 92868 (Onsite)

Position Type: Contract

Description:

• The Medical Authorization Assistant (Multipurpose Senior Services Program) will provide office and case management support services.
• The incumbent will serve as a contact between members, physicians, providers and CalOptima Health’s staff to gather information and serve as an interpreter as needed.
• Under the manager’s direction, the incumbent will be responsible for providing effective, efficient and courteous interaction with providers, members and families and other CalOptima Health staff.
• The incumbent will perform medical administrative and routine tasks specific to the assigned program and may also perform administrative support functions.

Duties & Responsibilities:

80% - Program Support

• Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
• Receives cases via fax, phone or electronically and enters new case information into the MSSPCare Online and Jiva systems.
• Conducts individual interviews/assessments with CalOptima Health members and providers to obtain intake information.
• Obtains information on requested services according to CalOptima Health’s services department guidelines, performs data entry into MSSPCare Online and Jiva and verifies eligibility.
• Contacts the health networks and CalOptima Health’s Customer Service regarding health network enrollments.
• Assists the Medical Case Managers and Social Workers in gathering medical records, obtaining appropriate information on diagnoses and procedures and following up on phone calls.
• Documents all contacts and case information in the appropriate MSSPCare Online and Jiva scripts or activity as appropriate.
• Assists the Medical Case Managers and Social Workers with services arrangement including durable medical equipment and other services and items provided through insurance(s) and community-based organizations.
• Performs high-volume data entry of 1915(c) Medicaid Waiver services into the MSSPCare online software system, as well as other appropriate databases, for tracking, monitoring, billing and trending of service utilization.
• Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
• Receives cases via fax, phone or electronically and enters new case information into the MSSPCare Online and Jiva systems.
• Conducts individual interviews/assessments with CalOptima Health members and providers to obtain intake information.
• Obtains information on requested services according to CalOptima Health’s services department guidelines, performs data entry into MSSPCare Online and Jiva and verifies eligibility.
• Contacts the health networks and CalOptima Health’s Customer Service regarding health network enrollments.
• Assists the Medical Case Managers and Social Workers in gathering medical records, obtaining appropriate information on diagnoses and procedures and following up on phone calls.
• Documents all contacts and case information in the appropriate MSSPCare Online and Jiva scripts or activity as appropriate.
• Assists the Medical Case Managers and Social Workers with services arrangement including durable medical equipment and other services and items provided through insurance(s) and community-based organizations.
• Performs high-volume data entry of 1915(c) Medicaid Waiver services into the MSSPCare online software system, as well as other appropriate databases, for tracking, monitoring, billing and trending of service utilization

15% - Administrative Support

• Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
• Generates monthly and other required reports from the databases as requested by the Medical Case Managers, Social Workers and/or health networks.
• Provides customer service to providers and members.
• Purchases, delivers and/or retrieves items from vendors and/or MSSP participants as requested by the Medical Case Managers or Social Workers.
• Conducts in-home visits to retrieve signatures on care plans or other documents.
• Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
• Generates monthly and other required reports from the databases as requested by the Medical Case Managers, Social Workers and/or health networks.
• Provides customer service to providers and members.
• Purchases, delivers and/or retrieves items from vendors and/or MSSP participants as requested by the Medical Case Managers or Social Workers.
• Conducts in-home visits to retrieve signatures on care plans or other documents.

Minimum Qualifications:

• High School diploma or equivalent required PLUS 2 years of experience in a health care or managed care setting required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
• Have access to means of transportation for work away from the primary office approximately 5% of the time.

Preferred Qualifications:

• 2 years of experience in invoice reconciliation and medical billing/coding required, preferably for Medicaid/Medi-Cal.
• 2 years of experience of data entry completion.
• Experience working with the needs of seniors or persons with disabilities (SPD) in a customer/member service capacity.
• Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese).

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