Pre-Authorization Specialist

You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.

Job Summary

The Pre-Authorization Specialist role works under the direction of the Director of Utilization Management and UM Review staff. The specialist provides comprehensive support to UM Reviewers while managing the full pre-authorization process for medical and behavioral health services for enrollees.

Key Responsibilities

Utilization Management Support :

Manages the main phone line, transfers calls to appropriate staff, opens UM cases by creating authorization shells in the electronic record, and sends requests for review to the appropriate UM reviewer. Attaches all documents related to UM activities to the electronic record.

Prior Authorization Management :

Manages the pre-authorization process, working closely with healthcare providers, care managers, and families to ensure timely approval of necessary services. Ensures that all services are approved in accordance with policies and medical necessity criteria.

Compliance and Facilitation :

Plays a critical role in facilitating access to care and ensuring compliance with regulatory and health plan requirements. This involves coordinating with providers and families to gather information and navigating the process to secure approvals.

Benefits

Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).

Health Benefits / Dental / Vision (Medix offers 6 different health plans : 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).

401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1 / 1, 4 / 1, 7 / 1, and 10 / 1).

Short Term Disability Insurance.

Term Life Insurance Plan.

• We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).

Medix Overview :

With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we're dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.