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Healthcare - Care Review Processor I

Key Facts

Remote From: 
Andorra, Anywhere
Full time
Mid-level (2-5 years)
English

Other Skills

  • •
    Time Management
  • •
    Detail Oriented
  • •
    Clerical Works

Roles & Responsibilities

  • HS Diploma or GED (required)
  • Associate degree (preferred)
  • 1-3 years' experience in an administrative support role in healthcare (must-have)
  • Experience with Medical Terminology

Requirements:

  • Provides telephone, clerical, and data-entry support for the Care Review team.
  • Enters authorizations and provider inquiries, including eligibility, benefits verification, provider contracting status, diagnosis and treatment requests, benefits coordination, and hospital census information (admissions and discharges) and billing codes.
  • Responds to requests for authorization of services submitted via phone, fax, and mail within Molina operational timeframes.
  • Contacts physician offices to obtain missing information or clarify details for authorization requests as directed by the Medical Director.

Job description


100% remote but most work PST hours
needs dual monitors and a docking station

Job Description:

Molina Healthcare 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 progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.
As part of this role, the selected candidate will be scheduled to work weekends in alignment with department coverage needs.

Job Qualifications
Required Education
HS Diploma or GED

Preferred Education
Associate degree

Preferred Experience
3+ years' experience in an administrative support role in healthcare, Medical Assistant preferred.


Must Have Skills:
1-3 years' experience in an administrative support role in healthcare.

Day to Day Responsibilities: • 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 via 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.

Required Years of Experience: 1-3 years' experience in an administrative support role in healthcare.

Experience. Experience with Medical Terminology.

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