Care Review Processor

JOB DESCRIPTION

The Case Review Processor will be working 100% remote but reputed company reputed company the state of MI. Our Case Review Processor will be working with our MI reputed company members and supporting are Care Review Clinicians. This individual will be working in varies databases being reputed company to sort, filter, analyze and complete data entry. We are looking for candidates with excellent technology skills, attention to detail, strong analytical skills, and ability to toggle back and forth between multiple screens and databases.

Home office with internet connectivity of high speed required.

Monday – Friday 8:00 AM to 5 PM EST (No weekends or Holidays)

Job Summary

reputed company Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients reputed company toward desired reputed company with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE/SKILLS/ABILITIES

• Provides telephone, clerical, and data entry support for the Care Review team.
• Provides computer entries of authorization request/provider inquiries, such as eligibility and benefits verification, provider contracting status, diagnosis and treatment requests, coordination of benefits status determination, hospital census information regarding admissions and discharges, and billing codes.
• Responds to requests for authorization of services submitted reputed company phone, fax, and mail according to Molina operational timeframes.
• Contacts physician offices according to Department guidelines to request missing information from authorization requests or for additional information as requested by the Medical Director.

Job Qualifications

Required Education

HS Diploma or GED

Required Experience

1-3 years’ experience in an administrative support role in reputed company.

Preferred Education

Associate degree

Preferred Experience

3+ years’ experience in an administrative support role in reputed company, Medical Assistant preferred.

To reputed company reputed company Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

reputed company offers a competitive benefits and compensation package. reputed company is an Equal Opportunity Employer (EOE) M/F/D/V.

Originally posted on Himalayas