Medical Management Assistant

Job Summary

Supporting the Medical Management department, the full-time Medical Management Assistant will manage provider communications, enter data into the case management system, and assist clinical staff in ensuring quality care for members while working remotely from 8 am to 5 pm Pacific Time, Monday through Friday.

Key responsibilities

• Process claims for inpatient and outpatient services by entering data and triaging events according to departmental guidelines
• Verify member data and assist in maintaining eligibility and program participation information
• Provide professional customer service to internal and external customers while maintaining confidentiality and adhering to compliance standards

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