Care Management Support Coordinator II
Job title: Care Management Support Coordinator II in Sacramento, CA at
Company:
Job description: Immediate need for a talented Care Management Support Coordinator II . This is a 12+ months (Contract to Hire ) opportunity with long-term potential and is located in Sacramento, CA(Remote). Please review the job description below and contact me ASAP if you are interested.Job ID:25-68238Pay Range: $20 - $23/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).Key Requirements and Technology Experience:
- Key Skills:Prior Authorizations and Medical Claims and Medical Insurance, and Medical Billing or appeals experience.
- Claims experience, Health insurance experience (product knowledge).
- Billing experience, appeals.
- High School Diploma/GED.
- Metric based (quality and production).
- Microsoft (outlook, excel).
- Good work ethics.
- Acts as a resource and supports the prior authorization request process to ensure that all authorization requests are addressed properly in the contractual timeline.
- Supports utilization management team to document authorization requests and obtain accurate and timely documentation for services related to the members healthcare eligibility and access.
- Knowledge of medical terminology and insurance preferred.
- Aids the utilization management team and maintains ongoing tracking and appropriate documentation on authorizations and referrals in accordance with policies and guidelines.
- Supports the authorization review process by researching and documenting necessary medical information such as history, diagnosis, and prognosis based on the referral to the clinical reviewer for determination.
- Verifies member insurance coverage and/or service/benefit eligibility via system tools and aligns authorization with the guidelines to ensure a timely adjudication for payment.
- Performs data entry to maintain and update various authorization requests into utilization management system.
- Supports and processes authorization requests for services in accordance with the insurance prior authorization list and routes to the appropriate clinical reviewer.
- Remains up-to-date on healthcare, authorization processes, policies and procedures.
- Performs other duties as assigned.
- Complies with all policies and standards.
- Reviewing authorization status, building authorizations, working with clinical.
- Team will have daily interaction via chat.
- NOTE-Sacramento, CA (Within 100 miles) or Woodland Hills, CA (Within 100 miles) or Princeton, CA (Within 100 miles) Will be working remotely, but must be in California .