Care Review Processor with Managed Care Exp. (Remote – PST)

Care Review Processor with Managed Care Exp. (Remote – PST)

We are looking to hire a candidate with the experience and skill sets mentioned for one of our major clients within the Health Insurance industry. This is a 3-month contract opportunity with the potential for extension (s). This is a REMOTE role.

 *This position is fully remote. Candidates must be able to work PST hours.  The schedule will be Tuesday – Saturday 10:00 am - 6:30 pm PST; Sunday - Thursday 10:00 am - 6:30 pm PST; Flex time- able to work late hours AND weekends.

**Candidates MUST have previous experience working for Molina with MCA HealthPlan who left on good standing. Right now the hiring manager would ONLY like to see candidates with previous Molina experience. If they left on good terms working for Misha Lehman or Christta Esguerra- Sullivan or for MCA.

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 Health Care 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: 

• Data Entry (Intake) - enters information in system from fax system.
• Verifies eligibility, coverage, request for missing information, redirecting to in-network facilities.
• Assist in phone queue questions.
• Correspondence - Letter generation - selects a correct template, minor grammar checks.
• Provide computer entries of authorization requests/provider inquiries by phone, mail, or fax. Including:
  • Verify member eligibility and benefits.
  • Determine provider contracting status and appropriateness.
  • Determine diagnosis and treatment requests.
  • Assign billing codes (ICD-9/ICD-10 and/or CPT/HCPC codes).
  • Determine COB status.
  • Verify inpatient hospital census-admits and discharges.
  • Perform 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 inter-rater reliability (IRR) testing and quality review audit scores.
• Notify Care Access and monitor 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.
• Candidates MUST have previous experience working for Molina with MCA HealthPlan who left on good standing.
• Previous Hospital or Healthcare clerical, audit, or billing experience.
• Experience with Medical Terminology.
• Computer skills and experienced user of Microsoft Office software.
• Accurate data entry at 40 WPM minimum.
• Demonstrated ability to communicate, problem-solve, and work effectively with people.
• Working knowledge of 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.
• Ability to work in a fast-paced environment.
• Able to work independently and as part of a team.
• Attention to detail, Fast learner, able to adapt to change, and multi-tasking skills are a MUST.
• High School Diploma/GED Required. High School Graduate (CRP); Some College (Correspondence Processor).

• Required/Provided Equipment: A laptop, keyboard, mouse, and headset will be required for this candidate to be successful in this role, and 2 monitors in addition to the laptop.

Other job specifications:

• Employment Type:  Contract to Hire (CTH), W2 only. NO C2C.
• Contracting Period:  3-month contracting opportunity with potential for extension (s).
• Job Location:  The position is fully remote. Candidates in the PST time are highly preferred. This person will work PST hours.

• The Schedule: Will be Tuesday – Saturday 10:00 am - 6:30 pm PST; Sunday - Thursday 10:00 am - 6:30 pm PST; Flex time- able to work late hours AND weekends.
• Contract Rate/Salary: $21/hr. on W2.
• Interview Process: Teams Meeting/Video Interview (1 interview).

Salary : $21