Medical Management Assistant

Job Summary

Supporting the Medical Management department, the full-time Medical Management Assistant will respond to provider calls and faxes, enter inpatient data into the case management system, and assist clinical staff in authorizing services while working remotely from Monday to Friday, 7am-4pm Pacific Time.

Key responsibilities

• Manage the authorization and processing of claims for inpatient and outpatient services by entering data and triaging events according to departmental guidelines
• Verify member data by researching eligibility, benefits, and network provider status to ensure quality care delivery
• Maintain effective communication with internal and external customers, ensuring services are provided within the benefit plan and addressing any issues promptly

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
• Working knowledge of Medicare and Medi-Cal guidelines preferred