CalOptima Health is seeking a highly motivated an experienced TEMPORARY - Medical Authorization Assistant to join our team.  The Medical Authorization Assistant (Multipurpose Senior Services Program) will provide office and case management support services. The incumbent will serve as a contact between members, physicians, providers and CalOptima Health’s staff to gather information and serve as an interpreter as needed. Under the manager’s direction, the incumbent will be responsible for providing effective, efficient and courteous interaction with providers, members and families and other CalOptima Health staff. The incumbent will perform medical administrative and routine tasks specific to the assigned program and may also perform administrative support functions. 

Position Information:

• Department: MSSP


• Work Arrangement: Full Office 


• Work Schedule: Monday to Friday 8am to 5pm 

Submission Information:

• The deadline to be guaranteed full review of your submission is due by Monday, February 10, 2025 by 9:00 p.m. PST.  This position will remain open for a minimum of seven (7) days, but may be extended if a lack of qualified applicants are received or if we are hiring multiple positions.

Duties & Responsibilities:

• 80% - - Program Support




• Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.


• Receives cases via fax, phone or electronically and enters new case information into the MSSPCare Online and Jiva systems.


• Conducts individual interviews/assessments with CalOptima Health members and providers to obtain intake information.


• Obtains information on requested services according to CalOptima Health’s services department guidelines, performs data entry into MSSPCare Online and Jiva and verifies eligibility.


• Contacts the health networks and CalOptima Health’s Customer Service regarding health network enrollments.


• Assists the Medical Case Managers and Social Workers in gathering medical records, obtaining appropriate information on diagnoses and procedures and following up on phone calls.


• Documents all contacts and case information in the appropriate MSSPCare Online and Jiva scripts or activity as appropriate.


• Assists the Medical Case Managers and Social Workers with services arrangement including durable medical equipment and other services and items provided through insurance(s) and community-based organizations.


• Performs high-volume data entry of 1915(c) Medicaid Waiver services into the MSSPCare online software system, as well as other appropriate databases, for tracking, monitoring, billing and trending of service utilization. 




• 15% - Administrative Support




• Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.


• Generates monthly and other required reports from the databases as requested by the Medical Case Managers, Social Workers and/or health networks.


• Provides customer service to providers and members.


• Purchases, delivers and/or retrieves items from vendors and/or MSSP participants as requested by the Medical Case Managers or Social Workers.


• Conducts in-home visits to retrieve signatures on care plans or other documents. 




• 5% - Completes other projects and duties as assigned. 

Minimum Qualifications:

• High School diploma or equivalent required PLUS 2 years of experience in a health care or managed care setting required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.


• Have access to means of transportation for work away from the primary office approximately 5% of the time.

Preferred Qualifications:

• 2 years of experience in invoice reconciliation and medical billing/coding required, preferably for Medicaid/Medi-Cal.


• 2 years of experience of data entry completion.


• Experience working with the needs of seniors or persons with disabilities (SPD) in a customer/member service capacity.


• Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese).

Required Licensure / Certifications:

• n/a

Knowledge & Abilities:

• Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.  


• Work independently and exercise sound judgment.


• Communicate clearly and concisely, both orally and in writing.


• Work a flexible schedule; available to participate in evening and weekend events.


• Organize, be analytical, problem-solve and possess project management skills.


• Work in a fast-paced environment and in an efficient manner.


• Manage multiple projects and identify opportunities for internal and external collaboration.


• Motivate and lead multi-program teams and external committees/coalitions.


• Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.