Care Review Processor with Managed Care Exp - New York, United States - OMG Technology

OMG Technology

Verified Company

New York, United States

1 week ago

Posted by:

Mark Lane

beBee recruiter

Description

_Care Review Processor with Managed Care Exp. (REMOTE)_

Position Summary:

Works within the Care Access and Monitoring (CAM) team to provide clerical and data entry support for Molina Members who require hospitalization and/or utilization review for other healthcare services.

Checks eligibility and verifies benefits, obtains and enters data into systems, processes requests, and triages members and information to the appropriate Healthcare Services staff to ensure the delivery of high quality, cost-effective healthcare services according to State and Federal requirements to achieve optimal outcomes for Molina Members.

Position Responsibilities:

Provide computer entries of authorization request/provider inquiries by phone, mail, or fax.
Verify member eligibility and benefits.
Determine provider contracting status and appropriateness.
Determine diagnosis and treatment requests.
Assign billing codes (ICD9/ICD10 and/or CPT/HCPC codes).
Determine COB status.
Verify inpatient hospital census admits and discharges.
Perform the action required per protocol using the appropriate Database.
Respond to requests for authorization of services submitted to CAM via phone, fax, and mail according to Molina operational timeframes.
Participates in interdepartmental integration and collaboration to enhance the continuity of care for Molina members including Behavioral Health and Long-Term Care.
Contact physician offices according to Department guidelines to request missing information from authorization requests or for additional information as requested by the Medical Director.
Provide excellent customer service for internal and external customers.
Meet department quality standards, including interrater reliability (IRR) testing and quality review audit scores.
Notify Care Access and Monitoring Nurses and case managers of hospital admissions and changes in member status.
Meet productivity standards. Maintain confidentiality and comply with the Health Insurance Portability and Accountability Act (HIPAA).
Participate in Care Access and Monitoring meetings as an active member of the team.
Meet attendance guidelines per Molina Healthcare policy.
Follow Standards of Conduct guidelines as described in Molina Healthcare HR policy.
Comply with required workplace safety standards.

Required Skills/Experience/Education:

Must have 2+ years of experience in a
Utilization Review Department in a Healthcare Managed Care Environment

Previous
Hospital or Healthcare clerical, audit, or billing experience

Computer skills and experienced user of Microsoft Office software.
Accurate data entry at 40 WPM minimum.
Experience with Medical Terminology and abbreviations.
Ability to think analytically and to problem solve.
Good communication and interpersonal/team skills.
Must have a high regard for confidential information.
Demonstrated ability to communicate, problemsolve, and work effectively with people.
Ability to work in a fastpaced environment.
Able to work independently and as part of a team.
High School Diploma/GED Required.

Other job specifications:

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Employment Type:
_ Contract to Hire (CTH),
W2 only. NO C2C
:

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Contracting Period:
_ 3-month contracting opportunity with potential for extension (s).
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_Contract Rate/Salary_:

$21/hr. on W-
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Interview Process:
_ Teams Meeting/Video Interview (1 interview).