Care Review Processor

Molina Talent Acquisition; Long Beach (CA); On-site; USD 42,000 - 56,000; Full time

Benefits offered by this job

Competitive benefits

Job summary

Molina Healthcare in Long Beach, CA seeks an Administrative Support Specialist to assist the utilization management team by handling clerical tasks, data entry, and correspondence. This role supports care delivery across the continuum, ensuring timely authorizations and accurate documentation while upholding confidentiality and regulatory standards.

Candidates with at least one year in health care administrative roles, strong attention to detail, and proficiency in Microsoft Office are

Qualifications

• 1+ year in administrative support, preferably health care.
• Experience as Correspondence Processor at Molina.
• Attention to detail and regulatory compliance for letters.
• Strong organizational and time-management skills.
• Excellent verbal and written communication.
• Willingness to learn new software and processes.
• Ability to handle confidential information.

Responsibilities

• Provide telephone, clerical and data entry support for care review.
• Enter authorizations, eligibility, benefits verification, and hospital data.
• Respond to service authorization requests within timeframes.
• Contact physician offices to request missing information per guidelines.

Skills

Attention to detail

Organizational skills

Time management

Verbal and written communication

Confidentiality

Microsoft Office

Tools

Microsoft Office Suite

Job description

Job Summary

Provides non-clinical administrative support to utilization management team and contributes to interdisciplinary efforts supporting provision of integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care.

Essential Job Duties

• Provides telephone, clerical and data entry support for the care review team.
• Provides computer entries of authorization request/provider inquiries, such as eligibility and benefits verification, provider contracting status, diagnosis and treatment requests, coordination of benefits status determination, hospital census information regarding admissions and discharges and billing codes.
• Responds to requests for authorization of services submitted via phone, fax and mail according to operational timeframes.
• Contacts physician offices according to department guidelines to request missing information from authorization requests or for additional information as requested medical directors.

Required Qualifications

• At least 1 year of experience in an administrative support role, preferably within a health care environment supporting correspondence or clinical communications, or equivalent combination of relevant education and experience.
• Previous experience as a Correspondence Processor at Molina.
• Strong attention to detail, and ability to work within regulatory and internal requirements for letter generation.
• Strong organizational and time-management skills, and ability to manage multiple letter queues and deadlines.
• Excellent verbal and written communication skills, and ability to ensure clarity and precision in all correspondence.
• Willingness to learn and adapt to new programs, software systems, and lines of business.
• Ability to research, obtain feedback, and integrate necessary adjustments into letters to meet quality standards.
• Ability to manage multiple tasks simultaneously, and ensure quality and compliance in all produced correspondence.
• Ability to maintain confidentiality and ensure compliance with all relevant guidelines, regulations, and policies in processing of clinical correspondence.
• Ability to work effectively in a fast-paced, high-volume environment, maintain accuracy and meet deadlines.
• Ability to collaborate effectively with team members and internal departments.
• Basic Microsoft Office suite/applicable software program(s) proficiency.

Preferred Qualifications

• Previous experience in a health care correspondence or clinical communications role, with an understanding of regulatory and accreditation rules related to clinical determinations.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V