Remote Medical Management Coordinator

SHPCA SCAN Health Plan; California; Hybrid; USD 28,000 - 38,000; Full time

Benefits offered by this job

Base salary range: $20.14 to $27.77

Remote Work Mode

Annual employee bonus program

Wellness Program

PTO

11 paid holidays + 1 floating + 1 bday

401(k) with employer match

Tuition reimbursement

Job summary

SCAN Health Plan is seeking a skilled Medical Management Support specialist for a remote role serving members and providers in California. The position focuses on data entry, eligibility verification, and coordinating care under clinical guidance.

Responsibilities include processing inpatient/outpatient data, authorizing services, maintaining strict privacy, and collaborating with network providers to ensure quality care. A strong customer service mindset and MS Office proficiency are required.

Qualifications

• High School Diploma or equivalent required.
• Associate’s Degree or equivalent experience preferred.
• 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.
• 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.
• Ability to work well in a fast-paced and dynamic environment.
• Ability to provide professional customer service.
• Proficient in MS Office.

Responsibilities

• The Job 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.
• You Will 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.
• 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

Data entry

Medical terminology

Customer service

Communication

Telephony

Education

High School Diploma or equivalent

Associate’s Degree or equivalent experience preferred

Tools

MS Office

Job description

SCAN Health Plan is seeking a skilled Medical Management Support specialist for a remote role serving members and providers in California. The position focuses on data entry, eligibility verification, and coordinating care under clinical guidance.

Responsibilities include processing inpatient/outpatient data, authorizing services, maintaining strict privacy, and collaborating with network providers to ensure quality care. A strong customer service mindset and MS Office proficiency are required.