L.A. Care Health Plan
Authorization Technician II (1 yr contract. weekends must))
L.A. Care Health Plan, Los Angeles, California, United States, 90079
Authorization Technician II (1 yr contract, weekends must)
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L.A. Care Health Plan
Salary Range: $47,840.00 (Min.) - $57,062.00 (Mid.) - $68,474.00 (Max.)
Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low‑income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.
Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County’s vulnerable and low‑income communities and residents and to support the safety net required to achieve that purpose.
Job Summary The Authorization Technician II supports the Utilization Management 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 timelines 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 requests 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, and other duties as assigned.
Duties
Process time‑sensitive authorization and pre‑certification requests to meet department timeframes and regulatory requirements.
Accurately and completely process referrals/authorizations and distribute a complete file to the UM Specialist within 2 hours of receipt; identify duplicate requests using the claims and verify existing authorization. Return duplicate files to claims or member services within 4 hours of receipt.
Flag and notify staff of priority requests based on date of receipt and established Turnaround Time criteria.
Maintain accurate filing of confidential member information, creating secure, complete files.
Interface with members, medical personnel and internal and external agencies; ensure compliance 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 (ICD‑10 codes, CPT, HCPCS codes).
Assist in the preparation of communication for authorization determinations, including preparing template letters for members and providers (approval, denial, deferral, modification, pay/education).
Assist in the technical aspects of the retrospective review process for authorizations and member or provider appeals, including data entry, logging, copying and preparing template letters for communication of appeal determinations.
Support UM Committee and audit activity via department performance reporting, ensuring accuracy of reports concerning inventory and regulatory standards.
Perform other duties as assigned.
Education Required
High School Diploma or High School Equivalency Certificate
Education Preferred
No specific education requirement beyond High School.
Experience
Required: At least 6 months of health care experience; experience working in a cross‑functional work environment.
Preferred: Experience in Medi‑Cal managed care; 1 year of experience in UM/Prior Authorization.
Skills
Required:
Demonstrated proficiency in medical terminology.
Strong verbal and written office communication skills.
Proficiency with Microsoft Office Suite and Adobe PDF.
Excellent organizational, interpersonal and time‑management skills.
Detail‑oriented and enthusiastic team player.
Preferred:
Knowledge of QNXT computer systems.
Knowledge of the UM patient referral process.
Knowledge of member health‑plan eligibility and benefits coverage.
Knowledge of health‑plan regulations and HMO/UM functions.
Knowledge of ICD‑10/CPT coding.
Proficient utilizing electronic medical records and documentation programs.
Licenses/Certifications
Required: None specified.
Preferred: Medical Coding Certification.
Training None specified.
Physical Requirements Light physical demands.
Additional Information Weekends and holidays may be required, as well as overtime based on business need.
Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.
This position is a limited duration position. The term of this position is a minimum one year and maximum two years from the start date unless terminated earlier by either party. Limited‑duration positions are full‑time positions and are eligible to receive full benefits.
Benefits
Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)
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at
L.A. Care Health Plan
Salary Range: $47,840.00 (Min.) - $57,062.00 (Mid.) - $68,474.00 (Max.)
Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low‑income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.
Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County’s vulnerable and low‑income communities and residents and to support the safety net required to achieve that purpose.
Job Summary The Authorization Technician II supports the Utilization Management 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 timelines 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 requests 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, and other duties as assigned.
Duties
Process time‑sensitive authorization and pre‑certification requests to meet department timeframes and regulatory requirements.
Accurately and completely process referrals/authorizations and distribute a complete file to the UM Specialist within 2 hours of receipt; identify duplicate requests using the claims and verify existing authorization. Return duplicate files to claims or member services within 4 hours of receipt.
Flag and notify staff of priority requests based on date of receipt and established Turnaround Time criteria.
Maintain accurate filing of confidential member information, creating secure, complete files.
Interface with members, medical personnel and internal and external agencies; ensure compliance 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 (ICD‑10 codes, CPT, HCPCS codes).
Assist in the preparation of communication for authorization determinations, including preparing template letters for members and providers (approval, denial, deferral, modification, pay/education).
Assist in the technical aspects of the retrospective review process for authorizations and member or provider appeals, including data entry, logging, copying and preparing template letters for communication of appeal determinations.
Support UM Committee and audit activity via department performance reporting, ensuring accuracy of reports concerning inventory and regulatory standards.
Perform other duties as assigned.
Education Required
High School Diploma or High School Equivalency Certificate
Education Preferred
No specific education requirement beyond High School.
Experience
Required: At least 6 months of health care experience; experience working in a cross‑functional work environment.
Preferred: Experience in Medi‑Cal managed care; 1 year of experience in UM/Prior Authorization.
Skills
Required:
Demonstrated proficiency in medical terminology.
Strong verbal and written office communication skills.
Proficiency with Microsoft Office Suite and Adobe PDF.
Excellent organizational, interpersonal and time‑management skills.
Detail‑oriented and enthusiastic team player.
Preferred:
Knowledge of QNXT computer systems.
Knowledge of the UM patient referral process.
Knowledge of member health‑plan eligibility and benefits coverage.
Knowledge of health‑plan regulations and HMO/UM functions.
Knowledge of ICD‑10/CPT coding.
Proficient utilizing electronic medical records and documentation programs.
Licenses/Certifications
Required: None specified.
Preferred: Medical Coding Certification.
Training None specified.
Physical Requirements Light physical demands.
Additional Information Weekends and holidays may be required, as well as overtime based on business need.
Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.
This position is a limited duration position. The term of this position is a minimum one year and maximum two years from the start date unless terminated earlier by either party. Limited‑duration positions are full‑time positions and are eligible to receive full benefits.
Benefits
Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)
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