CALAIM AUTHORIZATION COORDINATOR

POSITION SUMMARY:

The Transitions Auth Coordinator is responsible for managing the intake of new members, processing billing and authorizations, and supporting various administrative functions for the CalAim departments.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

The following is a representation of the major duties and responsibilities of this position. The agency will make reasonable accommodations to allow otherwise qualified applicants with disabilities to perform essential functions.

• Tracks and ensures referrals are processed within the time frames stated in the CalAim/CCT contract expectations.
• Fields incoming calls and makes outgoing calls to all potential members.
• Reviews and compiles intake documents to ensure paperwork is properly completed and submitted to Health Plans for authorization
• Tracks and update authorization status for new members.
• Performs eligibility screener in compliance with CalAim/CCT policies and procedures.
• Works with other departments to identify gaps in care for members and generate internal referrals.
• Uses the different Managed Care Provider (MCP’s) portals to submit authorization and reauthorizations requests for all CalAim services.
• Has a clear understanding of services provided under CalAim (ECM and CS) and CCT with the ability to clearly communicate them to potential members.
• Creates patient charts and uploads referral and authorization documentation into the EMR system.
• Processes approved authorizations and coordinates follow up activities for Case Managers
• Provides updates to external care partners regarding patient status and/or other relevant information.
• Completes CCT, CS, ECM visit logs and works through integration logs as needed.
• Assists with completing DHCS CCT forms (ITCP, FTCP, DTRF) based on the RN assessment.
• Assists in completing weekly and monthly CalAim MCP reports on CS Communications Log, CS Return Transmission File (RTF) and ECM Return Transmission File (RTF) & ECM Outreach Transmission File (OTF).
• Conforms to all agency policies and procedures.
• Maintains/conserves confidentiality of patient and agency information always with HIPAA regulations.
• Regularly attends and participates in scheduled case conferences, staff meetings and agency in-services.
• Follows policies and procedures as per Employee Handbook.
• Maintains all required credentials up to date.
• Reports Fraud and Abuse.
• Knowledge of mandated reporting.
• Conducts timely recording and/or documentation of client contact.
• Performs other duties as assigned.

QUALIFICATIONS:

• Bachelor's degree in Healthcare Administration, Business Administration or related field preferred.
• Has adequate computer experience in Microsoft Word and Excel.
• 2+ years of Administration experience.
• Is at least 18 years of age.
• Excellent communication skills and ability to engage others.
• Proper phone etiquette.
• Experience in working with electronic healthcare systems.
• Experience with developing reports.
• Strong organizational and follow up skills

PHYSICAL REQUIREMENTS:

• Stand, sit, talk, hear, reach, stoop, kneel and use of hands and fingers to operate computer, telephone, and keyboard on a frequent basis, up to 75% of the time.
• Close vision requirements due to computer work.
• Light to moderate lifting may be required up to 25lbs.