Care Review Processor

Molina Healthcare; United States; On-site; USD 29,000 - 41,000; Full time

Job summary

Molina Healthcare is seeking an Administrative Support professional to assist the utilization management team and contribute to an integrated delivery of care across the continuum.

The role emphasizes accurate data entry, timely correspondence, and adherence to regulatory guidelines, while collaborating with internal departments to enhance member care and cost efficiency.

Qualifications

• 1 year of administrative support experience, preferably in healthcare.
• Strong attention to detail and ability to adhere to regulatory requirements for letter generation.
• Excellent organizational and time-management skills to manage multiple queues and deadlines.
• Clear verbal and written communication skills ensuring precise correspondence.
• Willingness to learn new programs, software, and lines of business.
• Ability to research, gather feedback, and adjust letters to meet quality standards.
• Ability to handle multiple tasks simultaneously with accuracy and compliance.
• Maintain confidentiality and comply with guidelines and policies in processing clinical correspondence.
• Ability to thrive in a fast-paced, high-volume environment and collaborate with teams.

Responsibilities

• Provide telephone, clerical, and data-entry support for the care review team.
• Enter authorization requests and provider inquiries, including eligibility, benefits verification, and provider contracting status.
• Process requests for authorization of services via phone, fax, or mail within set timeframes.
• Contact physician offices to request missing information from authorization requests or for additional information.

Skills

Administrative support

Attention to detail

Time management

Communication skills

Confidentiality

Microsoft Office

Tools

Microsoft Office

Job description

JOB DESCRIPTION Job SummaryProvides 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.
• 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

Pay Range: $20.34 - $30.39 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.