Medical Management Coordinator I
About The Position
The Medical Management Coordinator I serves under the direction of the Supervisor of Medical Management Operations. Responsible for preparation efforts in key areas of focus, including Health Plan audits and reporting, internal audits, and data validation. This position is essential to maintaining an effective and efficient working relationship with all internal departments and external clients. Collaborates with staff dedicated to the execution of operational functions to maintain and support the strategic objectives of the managed care medical management division. Incumbent should possess knowledge of managed care industry standards, familiarity with government regulations, experience in interpreting full-service health plan contractual DOFR and delegation logic requirements, understanding of regulatory compliance, and experience in working on collaborative projects.
Requirements
- High School Diploma or equivalent required.
- Prior experience working in a clinic or health care call center.
- Minimum 2 years of experience working in a medical billing environment (IPA or HMO preferred), with pre-authorizations and reimbursement regulations on Medi-Cal, CCS, and other government programs required.
- Minimum 2 years’ experience working in a healthcare environment; knowledge of prior authorization and case management regulations governing Medi-Cal, Commercial, Medicare, CCS, and other government and commercial programs.
- Minimum 2 years of experience in quality improvement/data analysis/project management with successful deployment demonstrating measurable positive results.
Nice To Haves
- MA or Medical Billing certificate preferred.
Responsibilities
- Serves under the direction of the Supervisor of Medical Management Operations.
- Responsible for preparation efforts in key areas of focus, including Health Plan audits and reporting, internal audits, and data validation.
- Maintains an effective and efficient working relationship with all internal departments and external clients.
- Collaborates with staff dedicated to the execution of operational functions to maintain and support the strategic objectives of the managed care medical management division.
Benefits
- Medical, Dental and Vision insurance
- 403(b) Retirement savings plans with employer matching contributions
- Flexible Spending Accounts
- Commuter Flexible Spending
- Career Advancement & Development opportunities
- Paid Time Off & Holidays
- Paid CME Days
- Malpractice insurance and tail coverage
- Tuition Reimbursement Program
- Corporate Employee Discounts
- Employee Referral Bonus Program
- Pet Care Insurance
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
