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MAMMOTH HOSPITAL

Authorization Clerk

Career Insights for Eligibility Specialist

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What they do

An Eligibility Specialist provides assistance and information for people who apply for a government benefits program or health care program. Answers questions, assists with an application process, and reviews applications and relevant background information to determine eligibility. May assist eligible applicants with enrolling in a program.

$54,990 / year median in California

+4% projected growth

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Job Description

The Authorization Clerk assumes the responsibility for the timely and efficient management of obtaining insurance authorization for patient special procedures and surgeries for all Mammoth Hospital providers. Interacts professionally with all departments within the hospital, clinic setting, vendors and third party payers.
What You'll Do:
Performs telephonic support for on-line authorization of routine services. Provides direct support to primary care practices and specialty care providers regarding utilization, authorization, and referral activities. Knowledge of
ICD-10, CPT
codes, and the use of 3 M software to code doctor's orders. Data enter referrals for non-complex services including DME, physical therapy, inpatient and outpatient care, behavioral health services and testing as applicable, and special circumstance requests as defined by Utilization Management. Assists in gathering information needed for coordinators/case managers to determine continued authorization. Contacts providers with authorization, denial and appeals process information. Verifies eligibility of members and participating status of providers.
Who You Are:
Excellent communicator Detail oriented Good interpersonal skills Strong customer service skills
Qualifications:
High school diploma or equivalent required. Minimum of two years of experience in healthcare/medical-receptionist/information preferred. Knowledge of Coding preferred.
Job Information:
Full-time, day shifts. Starting wage $23.10 to $28.00 based on qualifications. The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job. An equal opportunity employer.