Medical Management Assistant

Job Summary

Supporting the Medical Management department, the full-time Medical Management Assistant will manage provider communications, data entry for inpatient services, and authorization of SCAN services while working remotely on a Tuesday to Saturday schedule from 7am-4pm or 8am-5pm Pacific Time.

Key responsibilities

• Authorize and process claims for inpatient and outpatient services by entering data into the case management system
• Verify member data and maintain data entry requirements according to established workflows and departmental policies
• Serve as a resource for internal and external customers, ensuring services are provided within the benefit plan and maintaining professional relationships with providers

Required qualifications

• High School Diploma or equivalent required; Associate's Degree or equivalent experience preferred
• 3+ years of medical experience in a managed care environment preferred
• Proficiency with data entry and knowledge of medical terminology required
• Utilization Management experience is required
• ICD-9, CPT coding experience and working knowledge of Medicare and Medi-Cal guidelines preferred