Medical Management Assistant

SCAN Health Insurance•Long Beach, CA

1d•$20 - $28•Remote

About The Position

Supports the Medical Management department at SCAN by responding to provider calls and faxes, entering inpatient and related data into the case management system (CCMS), authorizing SCAN services under the direction of clinical staff and supporting the Medical Management clinical staff in securing information needed to ensure the delivery of quality care and services to SCAN members. The role is remote and the work shift is Monday - Friday, 7am-4pm Pacific Time. SCAN is a nonprofit health organization serving over 500,000 people across Arizona, California, Nevada, New Mexico, Texas, and Washington, with nearly five decades of experience. They are dedicated to improving care for older adults and their work spans Medicare Advantage, fully integrated care models, primary care, care for the most medically and socially complex populations, and next-generation care delivery models. SCAN is committed to combining compassion with discipline, innovation with stewardship, and growth with integrity. They believe scale should strengthen their mission and are building the future of care for older adults, grounded in purpose, accountability, and respect for the people and communities they serve. They are looking for individuals who are curious about AI and its power to transform how they operate and serve their members.

Requirements

High School Diploma or equivalent required.
Proficiency with data entry required.
Knowledge of medical terminology is required.
Utilization Management experience is required.
Excellent communication skills; primarily telephonic required.
Strong organizational skills and the ability to prioritize.
Ability to multitask and work with limited supervision.
Ability to work well in a fast-paced and dynamic environment.
Ability to provide professional customer service.
Proficient in MS Office.
A background check is required.

Nice To Haves

Associate’s Degree or equivalent experience preferred.
3+ years of medical experience in a managed care environment is preferred.
ICD-9, CPT coding experience preferred.
Working knowledge of Medicare and Medi-Cal guidelines preferred.

Responsibilities

Supports the authorization, monitoring and the processing of claims for inpatient and outpatient services by entering data into designated system and triaging events per department guidelines.
Maintains data entry requirements by following established workflows and departmental policies and procedures.
Verifies member data by researching eligibility, member participation in SCAN Care Management Programs, benefits, network provider status, contracts and division of financial responsibility (DOFR).
Maintains telephone standards by answering calls within established turnaround times.
Serves as a resource for internal and external customers by ensuring services are provided within the benefit plan and utilizing contracted providers; works to develop a collaborative partnership with our network providers.
Ensures effective working relationships with providers by interacting in an appropriate, timely, professional manner, and promptly reporting any problems or issues.
Maintains the member‘s right to privacy and protects SCAN operations by keeping information confidential.
Utilizes department desktop procedures, workflows, job aids and training material.
Identifies barriers and brings to the attention of the supervisor/manager.
Communicates effectively with members by providing appropriate and timely information and by showing courtesy and respect each member, their caregivers and/or representatives.
Adheres to all quality, compliance and regulatory standards to achieve HCS and SCAN outcomes.
Contributes to team effort by accomplishing related results as needed.
Actively support the achievement of SCAN’s Vision and Goals.
Other duties as assigned.

Benefits

Base salary range: $20.14 to $27.77 per hour
Remote Work Mode
An annual employee bonus program
Robust Wellness Program
Generous paid-time-off (PTO)
Eleven paid holidays per year, plus 1 additional floating holiday, plus 1 birthday holiday
Excellent 401(k) Retirement Saving Plan with employer match
Robust employee recognition program
Tuition reimbursement
An opportunity to become part of a team that makes a difference to our members and our community every day!
A competitive compensation and benefits program
An excellent Retirement Savings program
A work-life balance