Medical Management Assistant (SCAN Temp)

SCAN Health Insurance; California; Remote; USD 28,000 - 38,000; Full time

Benefits offered by this job

Bonus program

Paid holidays

401(k) match

Tuition reimbursement

Remote work mode

Job summary

SCAN Health Insurance seeks an experienced Medical Management support professional for a temporary remote assignment in California. The role entails responding to provider calls, entering data into the CCMS, and authorizing services under clinical direction.

Responsibilities include data entry for inpatient and outpatient claims, eligibility verification, and maintaining privacy and standards to ensure quality care for SCAN members. Requires 3+ years in managed care and MS Office proficiency.

Qualifications

• High School Diploma or equivalent.
• 3+ years of medical experience in a managed care environment preferred.
• Proficiency with data entry.
• ICD-9, CPT coding experience preferred.
• Knowledge of medical terminology required.
• Utilization Management experience required.

Responsibilities

• Respond to provider calls and faxes.
• Enter inpatient and related data into the case management system (CCMS).
• Authorize SCAN services under clinical staff guidance.
• Support Medical Management staff to secure information for quality care.
• Process inpatient and outpatient claims data entry and triage per guidelines.
• Verify member data (eligibility, benefits, network status).
• Maintain telephone standards and provide professional customer service.
• Protect member privacy and SCAN confidentiality.

Skills

Multitask

Professional customer service

Data entry

MS Office

Communication

Time management

Research eligibility

Education

High School Diploma

Tools

CCMS

Job description

Founded in 1977 as the Senior Care Action Network, SCAN began with a simple but radical idea: that older adults deserve to stay healthy and independent. That belief was championed by a group of community activists we still honor today as the "12 Angry Seniors." Today, SCAN is a nonprofit health organization serving more than 500,000 people across Arizona, California, Nevada, New Mexico, Texas, and Washington, with over $8 billion in annual revenue. With nearly five decades of experience, we have built a distinctive, values-driven platform dedicated to improving care for older adults.

Our work spans Medicare Advantage, fully integrated care models, primary care, care for the most medically and socially complex populations, and next-generation care delivery models. We are building the future of care for older adults, grounded in purpose, accountability, and respect for the people and communities we serve.

*Temporary Remote Role approximately 3-6 months*

*Shift is Monday - Friday, 8am-5pm Pacific Time*

Supports the Medical Management department at SCAN by responding to provider calls and faxes, entering inpatient and related data into the case management system (CCMS), authorizing SCAN services under the direction of clinical staff and supporting the Medical Management clinical staff in securing information needed to ensure the delivery of quality care and services to SCAN members.

Supports the authorization, monitoring and the processing of claims for inpatient and outpatient services by entering data into designated system and triaging events per department guidelines.

Maintains data entry requirements by following established workflows and departmental policies and procedures.

Verifies member data by researching eligibility, member participation in SCAN Care Management Programs, benefits, network provider status, contracts and division of financial responsibility (DOFR).

Maintains telephone standards by answering calls within established turnaround times.

Serves as a resource for internal and external customers by ensuring services are provided within the benefit plan and utilizing contracted providers; works to develop a collaborative partnership with our network providers.

Maintains the member's right to privacy and protects SCAN operations by keeping information confidential.

Utilizes department desktop procedures, workflows, job aids and training material. Adheres to all quality, compliance and regulatory standards to achieve HCS and SCAN outcomes

High School Diploma or equivalent required. 3+ years of medical experience in a managed care environment is preferred.

Proficiency with data entry required.

ICD-9, CPT coding experience preferred.

Knowledge of medical terminology is required.

Utilization Management experience is required.

Ability to multitask and work with limited supervision.

Ability to provide professional customer service.

Proficient in MS Office.

20.14 to $27.77 per hour

Remote Work Mode

An annual employee bonus program

Eleven paid holidays per year, plus 1 additional floating holiday, plus 1 birthday holiday

Excellent 401(k) Retirement Saving Plan with employer match

Tuition reimbursement

An opportunity to become part of a team that makes a difference to our members and our community every day!

Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.

Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. LI-Remote

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information.