Medical Management Assistant - Prior Auth Clerk Remote
Medical Management Assistant - Prior Auth Clerk Remote
Posted on :
12-04-2025
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1 Vacancy
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Job Description
We are currently hiring a REMOTEMedical Management Assistant! If you have a strong attention to detail enjoy data entry and value being part of a team that makes a difference you may be the right person for the position!Apply today!
Classification:NONEXEMPTStatus & Schedule:FULLTIME MONDAY FRIDAY 8AM 5PM PTLocation:REMOTE (OR CA AZ MO AL FL)Salary:$18.04$21.47/HOURDepartment:MEDICAL SERVICESReports to:DIRECTOR OF MEDICAL SERVICESSupervision Exercised:NONSUPERVISORY
Job Purpose: Utilization Review Support
The content expert and accountable for supporting the medical services team including but not limited to Customer Service creating authorizations and administrative functions while maintaining a customeroriented approach.
Qualifications Education & Experience
- Minimum High School Diploma or equivalent
- One year of data entry required
- One year experience working in a healthcare setting or managed care
- Medical terminology CPT ICD 10 and HCPCS coding knowledge and experience
Essential Responsibilities: Utilization Review & Medical Management Support
- Create authorizations and enter into transactional work systems with proficiency
- Work with the Utilization Review Team including reviewing referrals and prior authorization requests which may include researching and obtaining additional information from providers as necessary or returning to sender per organizational policies and procedures
- Maintains efficient workflow in accordance with the Medical Management Department goals and objectives
- Maintain working knowledge of benefits as they relate to members enrolled in the Oregon Health Plan
- Educate customers about health plan benefit structure and relevant policies and procedures as applicable
- Match predefined clinical algorithm criteria to referral and prior authorization requests as appropriate
- Identify condition management care coordination and complex case management candidates and route to appropriate team member for review and action
- Work with Medical Management Team to meet department goals
- Raise questions and concerns relevant to the department. Research and gather relevant data and information to evaluate solution options
- Participate in quality improvement projects that support member provider and organizations strategic goals
- Represents the Medical Management Team through electronic telephonic and personal interactions with the public
- Prepare various documents and handle confidential in accordance with HIPAA guidelines and organizations procedures
- Participate in quality and organizational process improvement activities and teams when requested
- Ensure compliance with company policies and procedures as applicable to area(s) of responsibility
- Handle confidential information and materials appropriately and maintain a secure work area
- Other duties as assigned
Essential Responsibilities: ORGANIZATIONAL TEAM MEMBER
- Participate in quality and organizational process improvement activities when requested
- Support and contribute to effective safety quality and risk management efforts by adhering to established policies and procedures maintaining a safe environment promoting accident prevention and identifying and reporting potential liabilities
- Openly clearly and respectfully share and receive information opinions concerns and feedback in a supportive manner
- Work collaboratively by mentoring new and existing coworkers building bridges and creating rapport with team members across the organization
- Provide excellent customer service to all internal and external customers which includes team members members students visitors and vendors by consistently exceeding the customers expectations
- Recognize new developments and remain current in care management and coordination best practice standards and anticipate organizational modifications
- Advance personal knowledge base by pursuing continuing education to enhance professional competence
- Promote individual and organizational integrity by exhibiting ethical behavior to maintain high standards
- Represent organization at meetings and conferences as applicable
Knowledge Skills & Abilities:
- Knowledge of physical mental and oral health terminology
- Knowledge of standard concepts practices and procedure within the referral field
- Identify problems recommend solutions
- Work and interact effectively and positively with other staff members to build and enhance teamwork
- Knowledge of OHP program requirements benefit package eligibility categories and Oregon Division of Medical Assistance Program (MAP) rules and regulations preferred
- Knowledge of the Oregon Health Authorities Coordinated Care Organization required metrics
- Understanding of basic concepts of managed care
- Critical attention to detail for accuracy and timeliness
- Ability to report to work as scheduled and willingness to work a flexible schedule when needed
- Proficient in Microsoft Office Suite and Windows Operating System (OS)
- Training in or awareness of Health Literacy Poverty Informed Systemic Oppression language access and the use of healthcare interpreters uses of data to drive health equity Cultural Awareness TraumaInformed Care Adverse Childhood Experiences (ACEs) Culturally and Linguistically Appropriate Service (CLAS) Standards and universal access
- Knowledge and understanding of how the positions responsibilities contribute to the department and company goals and mission
- Knowledge of federal and state laws including OSHA HIPAA Waste Fraud and Abuse
- Awareness and understanding of equity diversity inclusion and the equity lens: ability to analyze the unfair benefits and/or burdens within a society or population by understanding the social political and environmental contexts of policies programs and practices
- Excellent people skills and friendly demeanor
- Critical thinking skills of using logic and reasoning to identify the strengths and weaknesses of alternative solutions conclusions or approaches to problems
- Attention to detail and organization skills
- Ability to handle stress and sensitive situations effectively while projecting a professional attitude
- Ability to communicate professionally both conversing and written
- Ability to work with diverse populations and interact with people of differing personalities and backgrounds
- Sensitive to economic considerations human needs and aware of how ones actions may affect others
- Ability to organize and work in a sensitive manner with people from other cultures
- Poised; maintains composure and sense of purpose
Working Conditions:
This position must have the ability to remain in a stationary position occasionally move about inside the office to access office machinery printer etc. frequently communicate and exchange accurate information.
Work Condition: Remote
Employee generally works within a remote work from home environment.
Travel may be required on occasion.
Hours of operations and specific staff scheduling may vary based on operational need.
Exposed to:
Employee is responsible for maintaining a safe work environment that is conducive to successful productivity and work output.
Machines equipment tools and supplies used: Constantly operates a computer or other office productivity machinery or software such as fax copier calculator multiline telephone system or scanner.
May answer a high volume of telephone calls complete documentation and use computer programs to either obtain or record information.
Multiple Duties: Must be able to work under conditions of frequent interruption and be able to stay on task.
Other Information:
This job description is intended to provide only basic guidelines for meeting job requirements. This job description is not designed to cover or contain a comprehensive listing of activities duties or responsibilities that are required of DOCS Management Services employees. Other duties responsibilities and activities may change or be assigned at any time with or without notice.
Employment Type
Full Time
Key Skills
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