Medical Management Resolution Specialist

Prominence Health; Reno (NV); On-site; USD 42,000 - 70,000; Full time

Benefits offered by this job

Loan Forgiveness Program

Competitive Compensation

Generous PTO

Medical Plan

Dental Plan

Vision Plan

401K with company match

Stock Plan

Job summary

Prominence Health is seeking a Medical Management Resolution Specialist (non-clinical) to help oversee daily operations within the Medical Management Department, ensuring accurate information and timely responses to inquiries in line with department policy and applicable state and federal requirements.

The role includes performing intake screening and data collection, ensuring licensed health professionals are available for necessary evaluation, and supporting smooth workflow across Medicare,

Responsibilities

• Monitor daily operations of the Medical Management Department and ensure complete and accurate information is provided on inquiries and timelines are met per policy and procedures.
• Perform intake screening and transfer of non-clinical data, collecting structured clinical data while ensuring licensing professionals are available for complex evaluation.

Job description

Responsibilities

Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience.

Responsibilities

Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience.

Learn more at: https://prominence-health.com/

Job Summary

The Medical Management Resolution Specialist (non-clinical staff) is responsible for monitoring the daily operations with the Medical Management Department, ensuring complete and accurate information is provided on all inquiries and deadlines are met per established departmental policy and procedures, state and federal requirements, and group health plan documents.

Medical Management Resolution Specialist are responsible for the initial screening (Intake Process). For initial screening, the organization limits use of non-clinical administrative staff to: Performance of review of service request for completeness of information; collection and transfer of non-clinical data; acquisition of structured clinical data; and activities that do not require evaluation or interpretation of clinical information. The organization ensures that licensed health professionals are available to non-clinical administrative staff while performing initial screening.

Benefit Highlights

• Loan Forgiveness Program
• Challenging and rewarding work environment
• Competitive Compensation & Generous Paid Time Off
• Excellent Medical, Dental, Vision and Prescription Drug Plans
• 401(K) with company match and discounted stock plan
• SoFi Student Loan Refinancing Program
• Career development opportunities within