Medical Management Resolution Specialist - Detail-Driven.

Prominence-Health-Plan; Reno (NV); On-site; USD 60,000 - 85,000; Full time

Benefits offered by this job

Loan Forgiveness Program

Challenging and rewarding work环境

Job summary

Prominence Health is a value-based care organization serving members and providers across Medicare, Medicare Advantage, and commercial payer partnerships. The Medical Management Resolution Specialist (non-clinical) ensures complete information on inquiries and deadlines, performing intake screening and data collection while coordinating with licensed professionals.

Role requires strong organization, communication, and multi-tasking skills, with familiarity in CMS guidelines and health plan

Qualifications

• Associates Degree or higher or equivalent work experience preferred.
• Detailed knowledge of CPT/HCPCS, ICD-9/10 coding, and medical terminology preferred.
• Previous experience in Utilization/Medical Management within a Health Plan environment is preferred.
• Must be extremely organized, detail oriented, meet deadlines, and work well under pressure.
• Language Skills: English proficiency in speaking and writing.

Responsibilities

• Monitor daily operations with the Medical Management Department.
• Ensure complete and accurate information on inquiries and deadlines.
• Screen intake and collect structured data and non-clinical information.
• Work with licensed health professionals during initial screening.
• Adhere to department policy, state and federal requirements.

Skills

Organizational skills

Communication

Problem solving

Critical thinking

Teamwork

Independent judgement

Multi-tasking

Initiative

Customer service

Education

Associates degree or higher

Tools

MS Word

MS Excel

MS Access

MS PowerPoint

MS Outlook

Job description

Prominence Health is a value-based care organization serving members and providers across Medicare, Medicare Advantage, and commercial payer partnerships. The Medical Management Resolution Specialist (non-clinical) ensures complete information on inquiries and deadlines, performing intake screening and data collection while coordinating with licensed professionals.

Role requires strong organization, communication, and multi-tasking skills, with familiarity in CMS guidelines and health plan