Medical Management Assistant

Quartz Health Solutions; Wisconsin; Hybrid; USD 29,000 - 36,000; Full time

Benefits offered by this job

Remote work option

Job summary

Quartz Health Solutions is seeking a detail-oriented Medical Management Assistant to support the Utilization Management team in Wisconsin. The role handles NCQA-compliant determinations and provides comprehensive patient/provider support for pre-service, concurrent, and post-service requests.

Responsibilities include notifying nursing staff, making protocol-driven approvals, and assisting with referrals, prior authorizations, and claims reviews, while delivering excellent telephone customer

Qualifications

• Requires high school diploma or equivalent.
• 1+ year healthcare/claims processing experience.
• Proficient in MS Office; Epic experience preferred.
• Excellent attention to detail and organization; strong communication.

Responsibilities

• Provides notification to nursing staff of requests/hospitalizations requiring review.
• Makes approval determinations per protocols; refers medical questions to nursing staff.
• Assists in medical review for referrals, prior authorizations, inpatient & claims reviews with supporting information.
• Provides telephone customer service regarding authorization requests, hospitalizations, and claims questions.

Skills

Communication skills

Attention to detail

Organizational skills

Education

High school diploma or equivalent

1+ year healthcare environment experience

MS Office and Epic experience

Data entry and word processing experience

Knowledge of NCQA requirements

Medical terminology knowledge

Strong written and verbal communication

Customer service in healthcare setting

Job description

Quartz is seeking detail oriented, well organized individual to support our Utilization Management team as a Medical Management Assistant. This role will work with in the NCQA requirements for completion and turn‑around times for requests and cases and assists with adherence to processes, making determinations based on policies/procedures in effect within the department and referring the next level of review when appropriate. This position will also provide detailed customer service to patients, providers and clinic staff regarding pre-service, concurrent and post-service requests with documentation in appropriate systems or databases.

Benefits

• Full-time, remote work environment available
• Work schedule an 8-hour schedule between the hours of 8:00am – 5:00pm, Monday – Friday
• Starting pay range: $21 - $26.45\hr.

Responsibilities

• Provides appropriate notification to nursing staff of all requests and hospitalizations requiring further review
• Makes approval determinations according to written protocols and guidelines as appropriate. Refers any medical questions or potential denial determinations to nursing staff for further review.
• Assists in the medical review process for referrals, prior authorizations, inpatient reviews and claims reviews by obtaining appropriate supporting information and documentation to assist in making necessity and benefit determinations as well as reconsiderations.
• Provides telephone customer service for members, providers, and other Health System or Quartz staff regarding authorization requests, hospitalizations and claim questions.

Qualifications

• High school diploma or equivalent
• 1+ year of experience working in a healthcare environment, such as claims processing, medical billing/insurance claims, or related experience
• Experience with computer applications such as MS Office and/or Epic
• Prior data entry and word processing experience is preferred
• Great attention to detail and excellent organizational skills
• Excellent oral and written communication skills, including phone skills
• Knowledge of medical terminology; previous experience in a medical office or medical field is preferred
• General knowledge of NCQA requirements is preferred

This full-time position will have the option to work in-person from our Madison, WI or Onalaska, WI office, in a hybrid capacity, or as a telecommuter. Hardware and equipment will be provided by the company, but candidates must have access to high-speed. Internet to successfully work from home.

Quartz offers competitive compensation, an excellent benefit package and a professional culture built on the foundations of Respect, Responsibility and Relationships. Quartz is a federal contractor and supports a safe, drug-free workplace. All employment offers are contingent upon successful completion of a pre-employment criminal background check.

Quartz values and embraces diversity and is proud to be an Equal Employment Opportunity, Aff... employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, gender identity or expression, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability.