Medical Assistant, Utilization Management

WelbeHealth, LLC.; Los Angeles (CA); Vor Ort; USD 70.000 - 74.000; Vollzeit

Benefits dieser Stelle

Full medical, dental, and vision保险

17 days PTO + 12 holidays + 6 sickdays

401(k) match and comprehensive health

Zusammenfassung

WelbeHealth, LLC. is seeking a Utilization Management Medical Assistant to review and audit authorization requests, ensuring services meet guidelines and are delivered appropriately. The role supports the UM program through chart reviews and efficient document routing.

The candidate should have a current MA certificate, CMA/RMA or equivalent, and familiarity with Medicare/Medicaid UM regulations. Experience with Athena EHR is preferred and a 2-year MA degree is required or equivalent training.

Qualifikationen

• Current MA Certificate (preferred)
• 2-year degree program in Medical Assistance accredited by CAAHEP/ABHES
• Certification by a Medical Assistant Certifying Organization (preferred)
• Minimum of one year chart auditing or UM review experience
• Experience with Athena EHR preferred
• Knowledge of Medicare/Medicaid UM regulations

Aufgaben

• Review consult summaries, imaging results, and procedure summaries to determine follow-up services
• Enter orders on behalf of PCP or ordering provider based on direction
• Manage clinical inboxes, emails, and fax queues for documents and authorizations
• Collaborate with UM Coordinators, UM Nurses, Medical Records, Provider Networking, and center staff
• Identify, document, and correct inconsistencies in participants’ orders with UM authorizations
• Work with providers and staff to resolve authorization/order gaps
• Meet operational performance requirements per data and company reporting

Kenntnisse

Medical Assistant Certificate

Medicare/Medicaid UM regulations

Ausbildung

CAAHEP/ABHES accredited MA program

Tools

Athena EHR

Jobbeschreibung

WelbeHealth PACE helps seniors stay in their homes and communities by providing medical care and community-based services. We believe in going the extra mile and aim to make a genuine difference in our participants’ lives.

The Utilization Management Medical Assistant (UM MA) is accountable for the review and audit of authorization requests to ensure services are authorized and meet standard medical guidelines. Ensuring that the right care is done in the right place at the right time is a critical aspect of this role. The UM MA is also accountable for supporting the organization’s UM program through close auditing of participants’ charts and authorization requests. This role requires strong working knowledge of UM regulatory and documentation standards.

• Conduct review of consult summaries, imaging results, procedure summaries, and more, to determine if additional follow up services are requested
• Enter orders on behalf of PCP or ordering provider, based on PCP direction and consult summaries from external providers
• Manage departmental clinical inboxes, email inboxes, and fax queues to ensure appropriate handling of documents and authorization requests
• Work closely with UM Coordinators, UM Nurses, Medical Records, Provider Networking, and center-based clinical staff to promote efficient and effective communication and document routing between multiple sources and systems
• Identify, document, and correct inconsistencies and gaps in participants’ orders with authorizations in the UM system
• Collaborate with providers, clinical staff, and others to resolve any authorization and order gaps identified
• Consistently meet operational performance requirements as detailed by data and company reporting

Job Requirements:

• Current MA Certificate; MA experience in a home health/clinical setting preferred
• 2-year degree program in Medical Assistance Accredited by the Commission on Accreditation of Allied Health Education Program (CAAHEP) or the Accrediting Bureau of Health Education Schools (ABHES)
• Certification by a Medical Assistant Certifying Organization approved by the State Medical Board, preferred
• Minimum of one (1) year of chart auditing or UM review experience, and a minimum of two (2) years of relevant administrative and clinical work
• Experience working in Athena Electronic Health Record, preferred
• Knowledge in Medicare and Medicaid UM regulations

Benefits of Working at WelbeHealth:

Apply your expertise in new ways as we rapidly expand. You will have the opportunity to design the way we work in the context of an encouraging and loving environment where every person feels uniquely cared for.

• Standard business working hours
• Full medical, dental, and vision insurance
• Work/life balance - we mean it! 17 days of personal time off (PTO), 12 holidays observed annually, and 6 sick days
• And additional benefits

Compensation consists of base salary plus bonus. WelbeHealth offers a competitive total rewards package that includes a 401(k) match, comprehensive healthcare coverage, and a broad range of additional benefits. Actual compensation will be determined based on experience and relevant qualifications.

$70,304 - $73,828.33 USD

At WelbeHealth, our mission is to unlock the full potential of our vulnerable seniors. In this spirit, please note that we have a vaccination policy for all our employees and proof of vaccination, or a vaccine declination form will be required prior to employment. WelbeHealth maintains required infection control and PPE standards and has requirements relevant to all team members regarding vaccinations.

Our Commitment to Diversity, Equity and Inclusion

At WelbeHealth, we embrace and cherish the diversity of our team members, and we're committed to building a culture of inclusion and belonging. We're proud to be an equal opportunity employer. People seeking employment at WelbeHealth are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information or characteristics (or those of a family member), pregnancy or other status protected by applicable law.

Voluntary Self-Identification

For government reporting purposes, we ask candidates to respond to the below self-identification survey.Completion of the form is entirely voluntary. Whatever your decision, it will not be considered in the hiringprocess or thereafter. Any information that you do provide will be recorded and maintained in aconfidential file.

As set forth in WelbeHealth’s Equal Employment Opportunity policy,we do not discriminate on the basis of any protected group status under any applicable law.

If you believe you belong to any of the categories of protected veterans listed below, please indicate by making the appropriate selection.As a government contractor subject to the Vietnam Era Veterans Readjustment Assistance Act (VEVRAA), we request this information in order to measurethe effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA. Classification of protected categoriesis as follows:

A "disabled veteran" is one of the following: a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or a person who was discharged or released from active duty because of a service-connected disability.

A "recently separated veteran" means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.

An "active duty wartime or campaign badge veteran" means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.

An "Armed forces service medal veteran" means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.