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 .

Expected salary: $20 - 23 per hour

Location: Sacramento, CA

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