Medical Management Assistant

Quartz Health Solutions • Madison, WI

419d • $41,600 - $41,600 • Remote

About The Position

The Medical Management Assistant role at Quartz is designed to support the Utilization Management team by ensuring compliance with NCQA requirements and facilitating the review process for medical requests. This position emphasizes attention to detail and excellent customer service, as it involves interacting with patients, providers, and clinic staff regarding various medical requests and documentation.

Requirements

• High school diploma or equivalent.
• 1+ year of experience working in a healthcare environment, such as claims processing, medical billing/insurance claims, or related experience.
• Experience with computer applications such as MS Office and/or Epic.
• Prior data entry and word processing experience is preferred.
• Great attention to detail and excellent organizational skills.
• Excellent oral and written communication skills, including phone skills.
• Knowledge of medical terminology; previous experience in a medical office or medical field is preferred.
• General knowledge of NCQA requirements is preferred.

Nice To Haves

• Bilingual applicants encouraged to apply.

Responsibilities

• Provides appropriate notification to nursing staff of all requests and hospitalizations requiring further review.
• Makes approval determinations according to written protocols and guidelines as appropriate.
• Refers any medical questions or potential denial determinations to nursing staff for further review.
• Assists in the medical review process for referrals, prior authorizations, inpatient reviews, and claims reviews by obtaining appropriate supporting information and documentation.
• Provides telephone customer service for members, providers, and other Health System or Quartz staff regarding authorization requests, hospitalizations, and claim questions.

Benefits

• Full-time, remote work environment available.
• Work schedule an 8-hour schedule between the hours of 8:00am - 5:00pm, Monday - Friday.
• Starting pay range: $20/hr.

What This Job Offers

• Job Type: Full-time
• Industry: Insurance Carriers and Related Activities
• Education Level: High school or GED