Medical office background and/or authorization knowledge
0-2 years of experience in Utilization Review or Healthcare clerical/billing; familiarity with medical terminology
Accurate data entry at 40 WPM minimum and strong Microsoft Office skills
High School Diploma/GED
Requirements:
Enter authorization requests and provider inquiries by phone, mail, or fax, and verify member eligibility and benefits
Determine provider contracting status, appropriateness, diagnosis/treatment requests, assign billing codes (ICD-9/ICD-10 and/or CPT/HCPC), and verify COB status
Respond to authorization requests for services and communicate with providers; contact physician offices to obtain missing information
Maintain confidentiality, comply with HIPAA, meet productivity and quality standards, and provide excellent customer service
Job description
• Will the roles be fully remote? Yes
• What is the expected schedule (include dates/time/timezone) M-F 8am-5pm CT
• What are the day to day job duties? These temps will be shelling authorizations which includes completing provider calls to complete follow up and/or provider redirection
• Top Skills Required: They must have medical office background and/or authorization knowledge.
• Required Years of Experience: 1
• What IT equipment is required (dual monitors, docking stations, etc.)? laptop, docking station, dual monitors, keyboard, headphones.
Summary: Works within the Care Access and Monitoring (CAM) team to provide clerical and data entry support for Molina Members that require hospitalization and/or utilization review for other healthcare services. Checks eligibility and verifies benefits, obtains and enters data into systems, processes requests, and triages members and information to the appropriate Health Care Services staff to ensure the delivery of high quality, cost-effective healthcare services according to State and Federal requirements to achieve optimal outcomes for Molina Members. Essential Functions: Provide computer entries of authorization request/provider inquiries by phone, mail, or fax. Including: o Verify member eligibility and benefits, o Determine provider contracting status and appropriateness, o Determine diagnosis and treatment request o Assign billing codes (ICD-9/ICD-10 and/or CPT/HCPC codes), o Determine COB status, o Verify inpatient hospital census-admits and discharges, o Perform action required per protocol using the appropriate Database. Respond to requests for authorization of services submitted to CAM via phone, fax and mail according to Molina operational timeframes. Participates in interdepartmental integration and collaboration to enhance the continuity of care for Molina members including Behavioral Health and Long Term Care. Contact physician offices according to Department guidelines to request missing information from authorization requests or for additional information as requested by the Medical Director. Provide excellent customer service for internal and external customers. Meet department quality standards, including inter-rater reliability (IRR) testing and quality review audit scores. Notify Care Access and Monitoring Nurses and case managers of hospital admissions and changes in member status. Meet productivity standards. Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA). Participate in Care Access and Monitoring meetings as an active member of the team. Meet attendance guidelines per Molina Healthcare policy. Follow Standards of Conduct guidelines as described in Molina Healthcare HR policy. Comply with required workplace safety standards. Knowledge/Skills/Abilities: Demonstrated ability to communicate, problem solve, and work effectively with people. Working knowledge of medical terminology and abbreviations. Ability to think analytically and to problem solve. Good communication and interpersonal/team skills. Must have a high regard for confidential information. Ability to work in a fast paced environment. Able to work independently and as part of a team. Computer skills and experienced user of Microsoft Office software. Accurate data entry at 40 WPM minimum. Required Education: High School Diploma/GED Required Experience: 0-2 years of experience in a Utilization Review Department in a Managed Care Environment. Previous Hospital or Healthcare clerical, audit or billing experience. Experience with Medical Terminology.
