Medical Management Specialist - Remote to Indiana

Professional Management Enterprises • Indianapolis, IN

55d • Remote

About The Position

BKG Enterprises is seeking a Medical Management Specialist for a work-from-home opportunity. This role is responsible for providing non-clinical support to medical management operations, including handling complex file reviews and inquiries from members and providers.

Requirements

• Requires a high school diploma
• Minimum of 5 years administrative and customer service experience; or any combination of education and experience which would provide an equivalent background
• Strong customer service/call center skills

Nice To Haves

• Knowledge of managed care or Medicaid/Medicare concepts strongly preferred

Responsibilities

• Gathers clinical information regarding case and determines appropriate area to refer or assign case (utilization management, case management, QI, Med Review)
• Conducts initial review of files to determine appropriate action required
• Maintains and updates tracking databases
• Prepares reports and documents all actions
• Responds to requests, calls or correspondence within scope
• Provides general program information to members and providers as requested
• May review and assist with cases
• May collaborate with external community-based organizations to facilitate and coordinate care under the direction of an RN Case Manager
• Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical information
• Acts as liaison between medical management operations and other internal departments to support ease of administration of medical benefits
• Provides mentoring and work direction to lower-level associates

Benefits

• Medical, dental, and vision insurance offered
• Supplemental insurace
• 80 hours of PTO after 90 days
• 10 paid holidays

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: High school or GED
• Number of Employees: 11-50 employees