Lead Authorization Technician

Job Summary

The Lead Authorization Technician is responsible for assisting the UM Manager to develop a successful and cohesive unit, with  high level of productivity to achieve the department's overall performance metrics. The position supports the UM Manager by serving as a department and staff resource in managing day to day referral management, information system/technology and operational issues. The position is responsible for monitoring the daily UM inventory reports/staff queues and ensuring cases are processed within the established timeframe requirements. The position also assists in triaging identified issues, resolving applicable issues and escalates appropriate issues to UM Manager. The position also acts as a point person for ad hoc projects involving other departments such as Claims and Member Services.
The Lead Authorization Technician supports the UM Specialist by handling all administrative functions of the authorization process including intake, logging, tracking and status follow-up.

The Lead Authorization Technician is responsible for making significant contributions to development and deliver proactive innovative service approaches, which will contribute to high member and provider satisfaction.  In addition, the lead will support the UM Manager and Medical Management Training and Compliance Specialist with analysis of internal audits to identify training opportunities.

Duties

Functional Elements: Maintenance and review of daily UM Open and Census reports: First-level triage of issues identified by Authorization Technicians. Technical Support to UM Specialist: Processing of time sensitive authorization and pre-certification requests to meet department timeframes and regulatory requirements; Computer Input; Accurately and completely processing referrals/authorizations in the MHC system and distributing a complete file  to UM Specialist within 2 hours of receipt; Identify duplicate requests using the claims and CSIM system to 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 TAT criteria for compliance; Accurate Filing/Maintenance of confidential member information. Creating secure, complete, files; Develop reports as required; analyzes results; formulate recommendations. (30%)

Functions as the lead of all authorization technician staff in UM referral management responsible for daily operational activities, including staffing , productivity, and work quality. Contributes to the hiring decisions, coaching and counseling and performance evaluation of assigned staff. (30%)

Assist in the preparation of member and provider communications for referral determinations, including, but not limited to preparing  template letters for members and providers  (authorization approval, denial, deferral, modification and pay/education). (20%)

Monitors the internal Member Services email communication and reports for urgent or unresolved member issues. (5%)

Support UM Committee and Audit activity via  Department performance reporting. (5%)

Perform other duties as assigned. (10%)

Duties Continued

Education Required

Education Preferred

Experience

Required:
At least 0-1 years of experience in managed care authorization processes and/or claims; Managed Care (Medi-Cal, HF, Medicare) with at least a 3-6 months of supervisory/lead experience.

Skills

Required:
Knowledge of medical terminology and AMA coding process (ICD-10, HCPC and CPT codes).

Strong verbal and written communication skills; computer literacy with proficiency with Microsoft Word, Excel, and Access.

Excellent organizational.

Adaptability to computer learning. 

Good interpersonal and time management skills. 

Must be detail-oriented and an enthusiastic team player. 

Ability to work independently. 

Ability to solve complex issues and identify creative solutions.

Persuasion Skills: Must be able to interface with members, medical personnel and other internal and external agencies and sometimes convince/persuade others to comply with L.A. Care requirements such as submitting requested information in a timely manner. Also to use the approved referral request forms with complete medical information (i.e. DX codes, CPT, HCPC codes).

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Physical Requirements

Additional Information