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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:
Handles 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
Requirements:
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