This position is responsible for providing support to the Medical Management department to ensure timeliness of outpatient or inpatient referral/authorization processing per state and federal guidelines. This position performs trouble-shooting when problems situations arise and takes independent action to resolve complex issues. The position also provides clear and concise written materials to members in their native language.

Responsibilities:

• Develops and maintains detailed project plans/schedules for required report and work plan submission.
• Manages department corrective action plan, work plan, and audit schedule.
• Alerts leadership and subject matter experts when task are due.
• Coordinates team working sessions to meet deliverables.
• Gather data to track corrective action and work plan responses and strategy.
• Ensure formatting of corrective action plans and work plans are professional and free of errors.
• Reviews report file layout specifications and directs analytic teams on reporting requirements.
• Indicate where data elements are located in the clinical systems for reporting and data capture.
• Performs initial data validation.
• Independently pulls self- service reports, sorts data appropriately, and performs initial data validation.
• Generates universes for audits and oversight activities.
• Completes data clean-up activities when needed.
• Trains team on pre-authorization, reimbursement, and case management regulations and their relation to monthly, quarterly, and semi- annual work plan submissions.
• Completes audit mapping documents, guides, and/or questionnaires.
• Identifies supporting documentation for audits.
• Pulls and prepares charts for audit files reviews.
• Coordinate audit day room reservation, set up, meeting invitations, and practice sessions if needed.
• System driver in audits.
• Prepares leadership for speaking roles in audits.
• Demonstrates excellent organizational and follow through skills.
• Demonstrate flexibility and ability to manage multiple complex situations and meet deadlines.
• Complies with HIPPA and PHI privacy rules and procedures in day to day work.
• Ensures only data for specific health plans are included in reports or work plans.
• Ability to incorporate managed care metric goals and results in to work plans or corrective action responses.
• Demonstrates excellent communications skills and interpersonal relationships.
• Edit documents translated by outside vendor or other entity to align with AltaMed Spanish voice and correct transcreation from the English copy.
• Produce content in target language while preserving the meaning of the original words in language copy adaption, includes transcreation of medical communications as a form of linguistic validation.
• Achieve all Spanish translations and attestations with attention to detail for ease of retrieving translated documents upon request.
• Provide, coordinates timely, accurate, culturally appropriate translations and/or reviews of AltaMed patient documents.
• Perform all other related duties as assigned.

Qualifications:

• High School Diploma or equivalent.
• MA or Medical Billing Certificate preferred.
• Minimum 2 years of experience working in a medical billing environment (IPA or HMO preferred), with pre-authorizations and reimbursement regulations pertaining to Medi-Cal, CCS and other government programs required.
• Prior experience in utilization management processing authorization referrals also required.
• Prefer prior Lead position experience.
• Translation Certification required or equivalent.

Skills and Abilities:

• Knowledge of medical terminology and coding (e.g., ICD-10, CPT, HCPCS).
• Knowledge of the health care industry, preferably managed care.
• Knowledge of computer skills in word processing, authorization systems and spreasheets.
• Ability to type a min. of 30 words per minute.
• Knowledge of HIPAA Guidelines including the PHI privacy requirements.
• Exceptional organizational skills.
• Bilingual English/Spanish preferred.
• Excellent communication and organizational abilities.
• Bilingual (English/ Spanish) and an understanding of multiple cultures.
• Ability to read, write and speak Spanish at a native fluency level.
• Solid knowledge of Spanish/English grammar and native syntax.
• Ability to natively translate, edit and proofread Spanish documents including clinic forms, printed collateral, emails, web pages, scripts, marketing collateral, clinical materials, and other communication vehicles.
• Familiarity with health care interpreting professional practices.
• Ability to translate clinical terms, including diagnosis, for patient letters.
• Ability to translate clinical materials and non-clinical (patient forms) as part of clinical workflows.
• Self-motivated and creative.
• Solid business acumen and problem-solving skills.
• Strong attention to detail, organization and time and project management skills.
• Act as a conduit, a clarifier, a cultural broker and an advocate for the patient by way of the written materials.

Job Type: Full-time

Pay: $23.00 - $28.00 per hour

Benefits:

• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Schedule:

• 8 hour shift

Ability to commute/relocate:

• Montebello, CA 90640: Reliably commute or planning to relocate before starting work (Required)

Language:

• Spanish (Required)

License/Certification:

• Certified Translator (Required)

Work Location: In person

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