[Remote] Authorization Assistant I-Temporary

Note: The job is a remote job and is open to candidates in USA. CareOregon is a healthcare organization seeking a Temporary Authorization Assistant I to provide technical and clerical support in various focus areas including physical health and behavioral health. The role involves verifying member eligibility, communicating with stakeholders, and ensuring compliance with regulations while maintaining high production and quality standards.ResponsibilitiesResponsible for supporting (1) focus areasAssist with complex work to the extent capableVerify member eligibility and determine the primary insurerVerify network providersVerify non-network providers are loaded into QNXTVerify 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 requestsCommunicate via the phone (placing and receiving phone calls) as necessaryObtain additional information as needed from the requestor or other providers in accordance with department processesProcess requests based on the members primary or secondary insurance as appropriate in accordance with department policies, procedures, and timelinesRespond to inquiries in a timely mannerResponsible for consistently meeting production and quality standardsDocument information received and action taken according to the department’s documentation standardsUpon 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 protocolsEnsure naming conventions are consistent across all platforms and in accordance with department documentation requirementsCreate appropriate member/provider notification based on request outcomeAct as a resource to both internal and external customers regarding authorization requestsMaintain confidentiality and adhere to HIPAA requirementsContribute to the Clinical Operations department effort to reach goalsParticipate in cross-departmental workgroups as neededLearn how to fix report errorsServe as a tester for system updates and/or implementations as neededContribute suggestions to improve processing guidesParticipate in job shadowing as neededCross-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)Notify providers of admission and discharge datesResearch and resolve questions related to hospitalizations or other facility admissions and dischargesWork with clinical staff to ensure length of stay follows required procedures and meets federal compliance standardsReview census reports daily to ensure timely review is conductedSkillsMinimum 1 year experience providing technical, clerical, or administrative support (includes customer service roles that provide technical, clerical, or administrative support)Awareness of the Oregon Health Plan (OHP) and Medicare A & B benefit packagesBasic knowledge of medical terminology, ICD10, and CPT coding helpfulAbility to consistently meet production standardsAbility to consistently meet high quality standardsAbility to and willingness to cross-train as neededStrong computer application skills in MS Office including Word, and OutlookAbility to learn business applicationsFast and accurate data entryAbility to attend to detail and accuracyGood organizational skillsGrowing ability to effectively manage multiple tasks, prioritize and process a high volume of workCommunicate effectively, both verbally and in writingGood customer service skillsAbility to be flexible and adaptableAbility to use good judgment, personal initiative, and discretion to perform job responsibilitiesAbility to work autonomously with moderate level of supervisionAbility to work effectively with diverse individuals and groupsAbility to learn, focus, understand, and evaluate information and determine appropriate actionsAbility to accept direction and feedback, as well as tolerate and manage stressAbility to see, read, and perform repetitive finger and wrist movement for at least 6 hours/dayAbility to hear and speak clearly for at least 3-6 hours/dayExperience working with electronic medical recordsExperience processing Medicare, Medicaid, or commercial plan authorization requestsExperience working with coding and medical terminologyBenefitsMedicalDentalVisionLifeAD&DDisability insuranceHealth savings accountFlexible spending account(s)Lifestyle spending accountEmployee assistance programWellness programDiscountsMultiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.)Strong retirement plan with employer contributionsPTOPaid State Sick TimePaid holidaysVolunteer timeJury dutyBereavement leaveCompany OverviewEveryone deserves great health care. It was founded in 1994, and is headquartered in Portland, Oregon, USA, with a workforce of 501-1000 employees. Its website is https://www.careoregon.org/.



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