[Hiring] Medical Management Assistant @SCAN Health Insurance

Role Description

Supports the Medical Management department at SCAN by responding to provider calls and faxes, entering inpatient and related data into the case management system (CCMS), authorizing SCAN 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 SCAN members.

You Will:

• Support 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.
• Maintain data entry requirements by following established workflows and departmental policies and procedures.
• Verify member data by researching eligibility, member participation in SCAN Care Management Programs, benefits, network provider status, contracts and division of financial responsibility (DOFR).
• Maintain telephone standards by answering calls within established turnaround times.
• Serve as a resource for internal and external customers by ensuring services are provided within the benefit plan and utilizing contracted providers; work to develop a collaborative partnership with our network providers.
• Ensure effective working relationships with providers by interacting in an appropriate, timely, professional manner, and promptly reporting any problems or issues.
• Maintain the member‘s right to privacy and protect SCAN operations by keeping information confidential.
• Utilize department desktop procedures, workflows, job aids and training material. Identify barriers and bring to the attention of the supervisor/manager.
• Communicate effectively with members by providing appropriate and timely information and by showing courtesy and respect to each member, their caregivers and/or representatives.
• Adhere to all quality, compliance and regulatory standards to achieve HCS and SCAN outcomes.
• Contribute to team effort by accomplishing related results as needed.
• Actively support the achievement of SCAN’s Vision and Goals.
• Other duties as assigned.

Qualifications

• High School Diploma or equivalent required. Associate’s Degree or equivalent experience preferred.
• 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.
• Proficient in MS Office.

Benefits

• Base salary range: $20.14 to $27.77 per hour
• Remote Work Mode
• An annual employee bonus program
• Robust Wellness Program
• Generous paid-time-off (PTO)
• Eleven paid holidays per year, plus 1 additional floating holiday, plus 1 birthday holiday
• Excellent 401(k) Retirement Saving Plan with employer match
• 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!