Remote Medical Management Associate

SCAN; Long Beach (CA); On-site; USD 27,744 - 38,255; Full time

Benefits offered by this job

Remote Work Mode

Annual bonus program

Wellness Program

PTO

Paid holidays

Job summary

SCAN is a nonprofit health organization focused on improving care for older adults. This temporary remote role supports the Medical Management department by handling provider calls, entering data, and authorizing services under clinical guidance.

The role emphasizes data accuracy, adherence to workflows, and collaboration with network providers to ensure quality care while protecting privacy. Ideal candidates bring 3+ years in managed care, strong communication, and proficiency with MS Office.

Qualifications

• 3+ years of medical experience in a managed care environment.
• Proficiency with data entry.
• ICD-9, CPT coding experience preferred.
• Knowledge of medical terminology.
• Utilization Management experience is required.
• Excellent communication skills; primarily telephonic required.
• Working knowledge of Medicare and Medi-Cal guidelines preferred.
• Strong organizational skills and the ability to prioritize.
• Ability to multitask and work with limited supervision.
• Proficient in MS Office.

Responsibilities

• Supports the authorization, monitoring and 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.
• Ensures effective working relationships with providers by interacting in an appropriate, timely, professional manner, and promptly reporting any problems or issues.
• 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. Identifies barriers and brings to the attention of the supervisor/manager.
• Communicates effectively with members by providing appropriate and timely information and by showing courtesy and respect each member, their caregivers and/or representatives.
• Adheres to all quality, compliance and regulatory standards to achieve HCS and SCAN outcomes.
• Contributes to team effort by accomplishing related results as needed.
• We seek Rebels who are curious about AI and its power to transform how we operate and serve our members.
• Actively support the achievement of SCAN’s Vision and Goals.
• Other duties as assigned.

Skills

Communication

Data entry

Medical terminology

Utilization Management

ICD-9/CPT coding

MS Office

Multitasking

Organizational skills

Telephonic skills

Education

High School Diploma

Associate degree preferred

Job description

SCAN is a nonprofit health organization focused on improving care for older adults. This temporary remote role supports the Medical Management department by handling provider calls, entering data, and authorizing services under clinical guidance.

The role emphasizes data accuracy, adherence to workflows, and collaboration with network providers to ensure quality care while protecting privacy. Ideal candidates bring 3+ years in managed care, strong communication, and proficiency with MS Office.