Medical Management Assistant - Prior Auth Clerk - REMOTE!

For a full job description, and to formally apply, please visit www.advancedhealth.com/careers

We are currently hiring a REMOTE Medical Management Assistant! If you have a strong attention to detail, enjoy data entry, and value being part of a team that makes a difference, you may be the right person for the position! Apply today!

Classification: NON-EXEMPT Status & Schedule: FULL-TIME, MONDAY – FRIDAY, 8AM – 5PM PT Location: REMOTE (OR, CA, AZ, MO, AL, FL) Salary: $18.04-$21.47/HOUR Department: MEDICAL SERVICES Reports to: DIRECTOR OF MEDICAL SERVICES Supervision Exercised: NON-SUPERVISORY

Job Purpose: Utilization Review SupportThe content expert and accountable for supporting the medical services team including but not limited to Customer Service, creating authorizations and administrative functions while maintaining a customer-oriented approach.

Qualifications, Education, & Experience

• Minimum High School Diploma or equivalent
• One year of data entry required
• One year experience working in a healthcare setting or managed care
• Medical terminology, CPT, ICD 10 and HCPCS coding knowledge and experience

Essential Responsibilities: Utilization Review & Medical Management Support

• Create authorizations and enter into transactional work systems with proficiency
• Work with the Utilization Review Team including reviewing referrals and prior authorization requests, which may include researching and obtaining additional information from providers, as necessary or returning to sender, per organizational policies and procedures
• Maintains efficient workflow in accordance with the Medical Management Department goals and objectives
• Maintain working knowledge of benefits as they relate to members enrolled in the Oregon Health Plan
• Educate customers about health plan benefit structure and relevant policies and procedures as applicable
• Match pre-defined clinical algorithm criteria to referral and prior authorization requests as appropriate
• Identify condition management, care coordination, and complex case management candidates and route to appropriate team member for review and action
• Work with Medical Management Team to meet department goals
• Raise questions and concerns relevant to the department. Research and gather relevant data and information to evaluate solution options
• Participate in quality improvement projects that support member, provider, and organization's strategic goals
• Represents the Medical Management Team through electronic, telephonic, and personal interactions with the public
• Prepare various documents and handle confidential in accordance with HIPAA guidelines and organization’s procedures
• Participate in quality and organizational process improvement activities and teams when requested
• Ensure compliance with company policies and procedures as applicable to area(s) of responsibility
• Handle confidential information and materials appropriately and maintain a secure work area
• Other duties as assigned

For a full job description, and to formally apply, please visit www.advancedhealth.com/careers

Job Type: Full-time

Pay: $18.04 - $21.47 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Employee discount
• Flexible schedule
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Professional development assistance
• Retirement plan
• Tuition reimbursement
• Vision insurance

Work Location: Remote

Apply For $21.47

Apply For $20.00

Apply For $18.04