Schedule: Remote position. Monday through Friday, 8:00 a.m. to 5:00 p.m. Pacific Time.
Description:
The Medical Management Support Specialist responds to provider calls and faxes, enters inpatient and related information into the case management system, processes service authorizations under the direction of clinical staff, and helps secure the information needed to deliver quality care and services to health plan members.
What You Will Do:
- Support the authorization, monitoring, and claims-processing activities for inpatient and outpatient services.
- Enter information into designated systems and triage events according to departmental guidelines.
- Follow established workflows, policies, and procedures to maintain accurate data.
- Research and verify member eligibility, benefits, care management program participation, provider network status, contracts, and division of financial responsibility.
- Answer provider calls within established turnaround times.
- Assist internal and external customers with confirming benefit coverage and the use of contracted providers.
- Build collaborative working relationships with network providers.
- Communicate with providers in a timely, professional, and appropriate manner.
- Promptly report provider-related problems or concerns to the appropriate supervisor or manager.
- Protect member privacy and maintain the confidentiality of health plan information.
- Use departmental procedures, workflows, job aids, and training materials to perform assigned responsibilities.
- Identify operational barriers and bring them to the attention of leadership.
- Provide members, caregivers, and representatives with accurate and timely information while demonstrating courtesy and respect.
- Follow all quality, compliance, and regulatory requirements.
- Contribute to team goals and complete other duties as assigned.
- Support the organization’s vision, goals, and efforts to explore how AI can improve operations and member service.
You Will Be Successful If:
- You communicate clearly and professionally, particularly by telephone.
- You provide responsive and professional customer service.
- You are organized and can effectively prioritize competing responsibilities.
- You can multitask in a fast-paced and changing environment.
- You can work independently with limited supervision.
- You maintain accuracy while handling high-volume data entry and administrative tasks.
- You build positive working relationships with providers, members, and internal teams.
- You consistently protect confidential and sensitive information.
What You Will Bring:
- High school diploma or equivalent required.
- Associate degree or equivalent professional experience preferred.
- Three or more years of medical experience in a managed care environment preferred.
- Utilization Management experience required.
- Knowledge of medical terminology required.
- Proficiency in data entry required.
- ICD-9 and CPT coding experience preferred.
- Working knowledge of Medicare and Medi-Cal guidelines preferred.
- Strong organizational and prioritization skills.
- Excellent written and verbal communication skills, with an emphasis on telephone communication.
- Proficiency with Microsoft Office.
About Impresiv Health:
Impresiv Health is a healthcare consulting partner specializing in clinical and operations management, enterprise project management, professional services, and software consulting services. We help our clients increase operational efficiency by delivering innovative solutions to solve their most complex business challenges.
Our approach is and has always been simple. First, think and act like the customers who need us, and most importantly, deliver what larger organizations cannot: tangible results that add immediate value at a rate that cannot be beaten. Your success matters, and we know it.
That’s Impresiv!
