Care Review Processor

Molina Talent Acquisition; United States; On-site; USD 40,000 - 56,000; Full time

Job summary

Molina Healthcare is seeking an administrative support assistant to assist the utilization management team with data entry, correspondence, and provider inquiries. You will help process authorization requests, verify eligibility, and maintain accurate records in a fast-paced environment.

Ideal candidates have at least 1 year in admin support, strong attention to detail, excellent written and verbal communication, and the ability to adapt to new software and regulatory requirements.

Qualifications

• 1+ year in administrative support, healthcare preferred or equivalent experience.
• Strong attention to detail and ability to follow regulatory requirements for letters.
• Excellent written and verbal communication skills for clear correspondence.
• Willingness to learn new programs and adapt to new software systems.

Responsibilities

• Provide telephone, clerical and data entry support for care review team.
• Enter authorizations, eligibility, benefits verification, and related provider inquiries.
• Respond to authorization requests via phone, fax, and mail within stated timeframes.
• Contact physician offices to obtain missing information as requested.

Skills

Administrative support

Data entry

Communication skills

Time management

Regulatory compliance

Attention to detail

Team collaboration

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.

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

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