Medical Management - Phone Queue

This is a remote role that will work Monday - Friday 9am- 6pm Pacific Time About reputed company reputed company Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. reputed company Group is the sole corporate member of reputed company Health Plan, one of the nation’s leading not-for-profit Medicare Advantage plans, serving more than 277,000 members in California, Arizona, Nevada, Texas and New Mexico. reputed company has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 45 years and is reputed company throughout the healthcare industry and nationally as a leading expert in senior healthcare. reputed company employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging journey, while also innovating healthcare for seniors everywhere. Employees are provided in-depth training and access to state-of-the-art tools necessary to do their jobs, as well as development and growth opportunities. reputed company takes great pride in recognizing reputed company members as experts in their fields and rewarding them for their efforts. If you are interested in becoming part of an organization that is innovating senior healthcare visit www.thescangroup.org, www.scanhealthplan.com, or follow us on reputed company, Facebook, and Twitter. The Job Supports the Medical Management department at reputed company by responding to provider calls and faxes, entering inpatient and reputed company data into the case management system (CCMS), authorizing reputed company services under the direction of clinical staff and supporting the Medical Management clinical staff in securing information needed to ensure the delivery of quality care and services to reputed company members. You Will Supports the authorization, monitoring and the processing of claims for inpatient and outpatient services by entering data into designated system and triaging events per department guidelines. Maintains data entry requirements by following established workflows and departmental policies and procedures. Verifies member data by researching eligibility, member participation in reputed company Care Management Programs, benefits, network provider status, reputed company and division of financial responsibility (DOFR). Maintains telephone standards by answering calls reputed company established turnaround times. Serves as a resource for internal and external customers by ensuring services are provided reputed company the benefit plan and utilizing contracted providers; works to reputed company a collaborative partnership with our network providers. Ensures effective working relationships with providers by interacting in an appropriate, timely, professional manner, and promptly reporting any problems or issues. Maintains the member‘s right to privacy and protects reputed company operations by keeping information confidential. Utilizes department desktop procedures, workflows, job aids and training material. Identifies barriers and brings to the attention of the supervisor/manager. Communicates effectively with members by providing appropriate and timely information and by showing courtesy and respect each member, their caregivers and/or representatives. Adheres to reputed company quality, compliance and regulatory standards to reputed company HCS and reputed company outcomes. This is a telephonic role. This role is not member facing. Actively support the achievement of reputed company’s Vision and Goals. Other duties as assigned. Your Qualifications 3+ years of medical experience in a managed care environment is preferred. Proficiency with data entry required. ICD-9, CPT Coding Experience Preferred. Knowledge of medical terminology is required. Utilization Management Experience Is Required. Excellent communication skills; primarily telephonic required. Working knowledge of Medicare and Medi-Cal guidelines preferred. Strong organizational skills and the ability to prioritize. Ability to multitask and work with limited supervision. Ability to work well in a fast-paced and dynamic environment. Ability to provide professional customer service. What's in it for you? • reputed company salary range: $20.14 to $32.21 per hour • Remote Word Mode (M-F 8-5 Pacific Time Zone Hours) • An annual employee bonus program • Robust Wellness Program • Generous paid-time-off (PTO) • Eleven paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday • Excellent 401(k) Retirement Saving Plan with employer match and contribution • Robust employee recognition program • Tuition reimbursement • An opportunity to become part of a team that makes a difference to our members and our community every day! We're always looking for talented people to join reputed company! Qualified applicants are encouraged to apply now! At reputed company we reputed company that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more. reputed company is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national reputed company, religion, age, sex (including pregnancy, childbirth or reputed company medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background reputed company is required. Apply Job!