Job Description
Description
BKG Enterprises is seeking Medical Management Specialist to join our team! This is a work-from home opportunity!
- Call Center
- Monday - Friday 8am-5pm
- Training pay: $18.50/hr after training pay $19.25/hr
- Medical, dental, and vision insurance offered
- Supplemental insurace
- 80 hours of PTO after 90 days
- 10 paid holidays
Responsible for providing non-clinical support to medical management operations calls, which includes handling the most complex file reviews and inquiries from members and providers.
- Primary duties may include but are not limited to:
- 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.
- Requirements
- Requires a high school diploma and a minimum of 5 years administrative and customer service experience; or any combination of education and experience which would provide an equivalent background. Knowledge of managed care or Medicaid/Medicare concepts strongly preferred.
- Position requires strong customer service/call center skills
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