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Medical Management Specialist - Remote to Indiana at Professional Management Enterprises
Indianapolis, Indiana, United States -
Full Time

Start Date

Immediate

Expiry Date

09 Feb, 26

Salary

20.0

Posted On

11 Nov, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

No

Skills

Customer Service, Call Center Skills, Administrative Support, File Review, Database Management, Report Preparation, Communication, Collaboration, Managed Care Knowledge, Medicaid Knowledge, Medicare Knowledge

Industry

Professional Services

Description
Description BKG Enterprises is seeking Medical Management Specialist to join our team! This is a work-from home opportunity! - Monday - Friday 8am-5pm - Pay: $20/hr -Medical, dental, and vision insurance offered -Supplemental insurance - 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 3 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
Responsibilities
The Medical Management Specialist provides non-clinical support to medical management operations, handling complex file reviews and inquiries. Responsibilities include gathering clinical information, conducting initial file reviews, and maintaining tracking databases.