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Medical Authorization Specialist

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Metroplus Health PlanNew York, NY
Full-time
  • Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care.
  • We believe that Health care is a right, not a privilege.
  • If you have compassion and a collaborative spirit, work with us.
  • You can come to work being proud of what you do every day.
  • About NYC Health + HospitalsMetroPlus Health Plan provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc.
  • As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus’ network includes over 27,000 primary care providers, specialists and participating clinics.
  • For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.
  • Position OverviewThe Care Management Associate, under the direction of the CMA Supervisor, is responsible for the daily activities of the member case intake functions and associated work flow, as well as for performing other duties associated with the coordination of member care as outlined for the MLTC/PCS Team. Job Description
  • Handles both incoming and outgoing calls on the MLTC/PCS ACD
  • Schedule appointments for Care management staff
  • Maintain files on members and tracks status of membership
  • Liaison between MetroPlus and HHA/PCA vendors re: communication about service to members
  • Assist members in scheduling necessary medical visits.
  • Enter prior approvals in the authorization System (CareConnect).
  • Use CareConnect system to enter authorization or services as per benefit of the program.
  • Notifies vendors of the start date of the services to member.
  • Notifies vendors of end of or cancellation of services for member.
  • Monitors the assigned queues in the authorization system (Care Connect) to ensure timely processing of service authorization requests
  • Tracks and monitors key information identified by the Team Lead for quality purposes.
  • Track and monitor members’ admission to hospitals, nursing home facilities, ER visits and unexpected outcomes
  • Track and monitor members’ documentation required for authorization and re-authorization of Personal Care Services.
  • This includes coordinating the completion of Doctor’s orders or M11qs
  • Print and mail Home Health Aide/Personal Care Aide Plan of Care
  • Track member’s short-term absence from geographic areas.
  • Coordinate the completion of Occupational Therapy Evaluations
  • Notifies Care Manager if a member cannot be contacted.
  • Complete missing information from documentation received
  • Confirm conflicting information accuracy in the documentation
  • All other tasks assigned by the Team Lead or the management team.
  • High School graduation or evidence of having satisfactory passed a High School Equivalency Program
  • One year of satisfactory full time experience.
  • Understanding of Medical terminology preferred.
  • Knowledge of ICD-9 and CPT-4 codes preferred.
  • Prior managed care experience preferred.
  • Prior experience customer services/call center experience preferred.

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