Authorization Assistant-Temporary

Essential Responsibilities ' Responsible for supporting (1) focusareas. ' Assist with complex work to the extent capable. ' Verifymember eligibility and determine the primary insurer. ' Verify networkproviders. ' Verify non-network providers are loaded into QNXT. 'Verify codes and benefits, including benefit limits, based on theapplicable line of business (e.g., Medicare, Medicaid, etc.). 'Communicate with members, providers, and all business associates inaccordance with state and federal requirements as needed to completerequests.& #8239; ' Communicate via the phone (placing and receivingphone calls) as necessary. ' Obtain additional information as neededfrom the requestor or other providers in accordance with departmentprocesses. ' Process requests based on the members primary or secondaryinsurance as appropriate in accordance with department policies,procedures, and timelines. ' Respond to inquiries in a timely manner.' Responsible for consistently meeting production and qualitystandards. ' Document information received and action taken accordingto the department's documentation standards. ' Upon the completion ofrequests, organize and review documents to ensure all requiredinformation is accurate and complete in the system and in accordancewith established protocols. ' Ensure naming conventions are consistentacross all platforms and in accordance with department documentationrequirements. ' Create appropriate member/provider notification basedon request outcome. ' Act as a resource to both internal and externalcustomers regarding authorization requests. ' Maintain confidentialityand adhere to HIPAA requirements. ' Contribute to the ClinicalOperations department effort to reach goals. ' Participate incross-departmental workgroups as needed. ' Learn how to fix reporterrors. ' Serve as a tester for system updates and/or implementationsas needed. ' Contribute suggestions to improve processing guides. 'Participate in job shadowing as needed. ' Cross-train and attend toduties outside of focus area as needed: ' Process retroactiveauthorization 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 dates ' Research andresolve questions related to hospitalizations or other facilityadmissions and discharges ' Work with clinical staff to ensure lengthof stay follows required procedures and meets federal compliancestandards ' Review census reports daily to ensure timely review isconducted Experience and/or Education Required ' Minimum 1 yearexperience providing technical, clerical, or administrative support(includes customer service roles that provide technical, clerical, oradministrative support) Preferred ' Experience working with electronicmedical records ' Experience processing Medicare, Medicaid, orcommercial plan authorization requests ' Experience working with codingand medical terminology Knowledge, Skills and Abilities Required We arean equal opportunity employer

Created: 2026-02-09