Authorization Technician II Job at L.A. Care Health Plan (Los Angeles)

Authorization Technician II

L.A. Care Health Plan

Location:
United States , Los Angeles

Category:
-

Contract Type:
Employment contract

Salary:

47840.00 - 68474.00 USD / Year

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Job Description:

The Authorization Technician II supports the Utilization Management (UM) Specialist by handling all administrative and technical functions of the authorization process including intake, logging, tracking and status follow-up. The Authorization Technician II collects information required by clinical staff to render decisions, assists the Manager and Director of the Utilization Management department in meeting regulatory time lines by maintaining an accurate database inventory of referral authorizations, retrospective reviews, concurrent reviews and grievance/appeal requests, and prepares UM Activity and Weekly Compliance Reports. In addition, the position performs data entry and processing of referrals/authorizations in the system, authorizes request consistent with auto authorization criteria, maintains confidentiality when communicating member information, and assists with the communication of determinations by preparing template letters for members/ providers, with other duties as assigned.

Job Responsibility:

Supports the Utilization Management (UM) Specialist by handling all administrative and technical functions of the authorization process including intake, logging, tracking and status follow-up
Collects information required by clinical staff to render decisions
Assists the Manager and Director of the Utilization Management department in meeting regulatory time lines by maintaining an accurate database inventory of referral authorizations, retrospective reviews, concurrent reviews and grievance/appeal requests
Prepares UM Activity and Weekly Compliance Reports
Performs data entry and processing of referrals/authorizations in the system
Authorizes request consistent with auto authorization criteria
Maintains confidentiality when communicating member information
Assists with the communication of determinations by preparing template letters for members/ providers
Processing of time sensitive authorization and pre-certification requests to meet department timeframes and regulatory requirements
Computer Input: Accurately and completely processing referrals/authorizations and distribute a complete file to UM Specialist within 2 hours of receipt
Identify duplicate requests using the claims and verify existing authorization
Independently identifying and appropriately returning to claims or member services any file that is a duplicate to one already processed in the system
Appropriately documenting what information was used in making this determination within 4 hours of receipt
Appropriate identification and timely notification of time sensitive requests
Appropriately identifying for the staff which you support, request that are priority based on date of receipt and established Turnaround Time criteria for compliance
Accurate filing/maintenance of confidential member information
Creating secure, complete, files
Interface with members, medical personnel and other internal and external agencies
Ensure all comply with L.A. Care requirements such as submitting requested information in a timely manner and using the approved Authorization Request form with complete medical information i.e.: ICD 10 codes, CPT, HCPC codes
Assist in the preparation of communication for authorization determinations, including, but not limited to preparing template letters for members and providers (authorization approval, denial, deferral, modification and pay/education)
Assist in the technical aspects of the retrospective review process for authorizations and Member or Provider Appeals, including, but not limited to computer data entry, logging, copying, preparing of template letters for communication of appeal determinations to members, providers and partners (appeal uphold or overturn) and filing: Set up GNA files for review, log and keep track all due dates for each file
Inform nurses of a new case received from Grievance and Appeals Specialist
Submit all Grievances and Appeals response letters to Grievances Specialist on daily basis
Support UM Committee and Audit activity via Department performance reporting
Assure the accuracy of reports concerning inventory and department proficiency in maintaining regulatory standards and time frames
Perform other duties as assigned

Requirements:

High School Diploma/or High School Equivalency Certificate
At least 6 months of health care experience
Experience working in a cross functional work environment
Demonstrated proficiency in Medical Terminology required
Strong verbal and written office communication skills
Proficient with Microsoft Office Suite and Adobe PDF
Excellent organizational, interpersonal and time management skills
Must be detail-oriented and an enthusiastic team player

Nice to have:

Experience in Medi-Cal managed care
1 year of experience in UM/Prior Authorization
Knowledge of QNXT computer systems a plus
Knowledge of the UM patient referral process
Knowledge of member’s health plan eligibility
Knowledge of member’s benefits coverage
Knowledge of Health Plan regulations
Knowledge of HMO/UM functions
Knowledge of ICD-10/CPT coding
Proficient utilizing electronic medical records and documentation programs
Medical Coding Certification

What we offer:

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Additional Information:

Job Posted:
December 29, 2025

Employment Type:

Fulltime

Work Type:

On-site work

L.A. Care Health Plan - All Job Offers

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Authorization Technician II

L.A. Care Health Plan

Location:
United States , Los Angeles

Category:
-

Contract Type:
Employment contract

Salary:

Job Description:

Job Responsibility:

Requirements:

Nice to have:

Additional Information:

Job Posted:
December 29, 2025

Looking for more opportunities? Search for other job offers that match your skills and interests.

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Authorization Technician II

L.A. Care Health Plan

Location:United States , Los Angeles

Category:-

Contract Type:Employment contract

Salary:

Job Description:

Job Responsibility:

Requirements:

Nice to have:

Additional Information:

Job Posted:December 29, 2025

Looking for more opportunities? Search for other job offers that match your skills and interests.

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Job Posted:
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