Medical Management Representative

Health One Alliance, LLC; Dalton (GA); On-site; USD 35,000 - 50,000; Full time

Benefits offered by this job

401(k) with 4% match

Competitive salary

Health Insurance

Vision Insurance

Dental Insurance

Paid Time Off

Job summary

Health One Alliance, LLC in Dalton, Georgia is hiring a Medical Management Representative to support the clinical team. The role involves conducting educational calls to members and assisting with case management and utilization management.

The ideal candidate should have a high school diploma, proficiency in Microsoft Office, and a background in customer service or fundamentals of nursing. A flexible mindset is essential for adapting to dynamic work conditions.

Qualifications

• Experience in a customer service role preferred.
• Fundamentals of nursing or equivalent knowledge required.
• Adaptable to a fast-paced environment.

Responsibilities

• Conduct educational calls advising members of benefits.
• Manage work queues and screen members for eligibility.
• Act as a liaison to clinical staff.

Skills

Customer service experience

Proficiency in Microsoft Office (Outlook, Word, Excel)

Knowledge of medical terminology

Ability to manage multiple projects

Strong communication skills

Education

High school diploma or equivalent

Job description

Job Purpose

The Medical Management Representative supports the clinical team and serves as a proactive resource for members related to case management and utilization management.

Essential Job Duties

• Conduct educational telephone calls advising members of available benefits, services, and programs.
• Refer members to population health management programs as appropriate.
• Reach out to members with identified gaps in care to assist in securing providers and arranging appointments.
• Manage system work queues, screen identified members for eligibility, prior case activities, recent claims, customer service inquiries, and authorization history; assign members to the clinical team for call outreach and intervention.
• Facilitate research and analysis of inquiries, complaints, and other program-related inquiries.
• Act as a liaison to clinical staff.
• Collect and enter data as appropriate to process prior authorization requests.
• Participate in projects as needed, performing duties such as project research, data entry, and file management.
• Work with internal and external persons and entities to research and resolve requests, problems, and questions in a timely manner.
• Work overtime as needed.
• Maintain regular and predictable attendance.
• Consistently demonstrate compliance with HIPAA regulations, professional conduct, and ethical practice.
• Encourage and promote company culture throughout the organization.

Qualifications

• High school diploma or equivalent.
• Preferred: Experience in a customer service role.
• Proficient in Microsoft Office (Outlook, Word, Excel).
• Fundamentals of nursing or equivalent knowledge.
• Working knowledge of NCQA preferred.
• Must be able to work independently and creatively.
• Ability to manage multiple projects and priorities.
• Adaptable to a fast-paced and changing environment.
• Proficient in interpreting benefits and contract language.
• Knowledge of medical terminology.

Physical Requirements

• Prolonged periods of sitting at a desk and working on a computer.
• Moderate to significant stress in meeting deadlines and managing day-to-day responsibilities.
• Must be able to drive a vehicle and travel during day or overnight as required.

Benefits

• 401(k) (4% match, immediate vesting)
• Accident insurance
• Competitive salary
• Critical illness insurance
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health & Wellness Program
• Health savings account
• Life & AD&D insurance
• Long-term disability
• Medical insurance
• Paid time off
• Pet insurance
• Short-term disability
• Vision insurance

Equal Opportunity Employer

HealthOne is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, disability, sex, age, ethnic or national origin, marital status, sexual orientation, gender identity or presentation, pregnancy, genetics, veteran status, or any other status protected by state or federal law.