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Authorization Specialist in Irvine CA at Parallon

Date Posted: 12/6/2018

Job Snapshot

  • Employee Type:
  • Location:
    Irvine CA
  • Job Type:
  • Experience:
    At least 3 year(s)
  • Date Posted:

Job Description

Do you have exceptional customer service and the ability to plan organize and exercise sound judgment?  Do you have demonstrated communication, problem solving and case management skills and the ability to act/decide accordingly?
Now is the time to join our team of motivated and nurturing individuals working to assist patients with their Medicaid Eligibility screening and enrollment.  Ideal candidates will have a steady work knowledge of medical terminology, practices and procedures, as well as laws, regulations, and guidelines.  You should also share a passion for our purpose, "To serve and enable those who care for and improve human life in their community."
Does this sound like you?  If so, APPLY TODAY.  See what makes us a fabulous place to work!     

Parallon is now seeking a Full-Time Medicaid Eligibility Specialist
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  • We offer you an excellent total compensation package, including competitive salary, excellent benefit package and growth opportunities. We believe deeply in our team and your ability to do excellent work with us.
  • Your benefits package allows you to select the options that best meet the needs of you and your family. Benefits include 401k, paid time off medical, dental, flex spending, life, disability, tuition reimbursement, employee discount program, employee stock purchase program and student loan repayment.

  • Responsible for posting of new Referrals (as needed) for assignment of submission.
  • Ensure thorough review of accounts for proper submission. 
  • Review of Proof of Eligibility (POE) to ensure coverage of services being rendered
            Aid code review
            Health plans
            Medicare Part A/B
  • Ensure the physical file is complete with all documentation needed for submission
           If missing items, request via patient management system: PME/H3.
           Determine when appropriate to escalate for further assistance
  • Tracking of pending documentation: medical records, SOC Clearance, Patient discharge prior to submission.
  • Check authorization portal for adjudications every 5 days for CA and 2 days for NV & document in patient management system
          Approvals, Modified, Deferrals, and Denials.
  • Follow timely processing of accounts to ensure the 5 day submission requirement
  • Inform Unit Manager/Regional Director of adjudication patterns and trends
  • Document all work efforts in patient management system timely and accurately.

Job Requirements


  • College degree preferred or high school diploma (equivalent).
  • Minimum three years of hospital/medical business office experience with insurance procedures and patient interaction
  • Understanding of patient confidentiality to protect the patient and the clinic/corporation. 
  • Ability to collect, synthesize and research complex or diverse information.
  • Must have CAN or MA (Certified Nursing Assist, Medical Assistant) background.
  • Knowledgeable of Medicaid and Utilization Management Authorizations is preferred.
  • Proficient with computer and basic software including Excel, Word and Outlook.
  • Basic knowledge of office equipment use and maintenance including network printer, copier, postage machine, fax machine.

Parallon believes that organizations that continuously learn and improve will thrive. That’s why after more than a decade we remain dedicated to helping hospitals and hospital systems operate knowledgeably, intelligently, effectively and efficiently in the rapidly evolving healthcare marketplace, today and in the future. As one of the healthcare industry’s leading providers of business and operational services, Parallon is uniquely equipped to provide a broad spectrum of customized revenue cycle services. 

We are an equal opportunity employer and we value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.