Remote Medical Management Coordinator

SCAN Health Insurance; Sacramento (CA); Remote; USD 28,000 - 38,000; Full time

Benefits offered by this job

Remote Work Mode

Annual employee bonus program

Wellness Program

Generous paid-time-off (PTO)

Eleven paid holidays plus floating and

Job summary

SCAN Health Insurance in California is seeking a dedicated Medical Management Associate to support provider calls, enter data into CCMS, and authorize services under clinical staff guidance.

You will handle claims processing data entry, verify eligibility, protect privacy, and maintain professional relationships with providers while adhering to quality standards. This remote role offers a base hourly rate and benefits.

Qualifications

• High School Diploma or equivalent required.
• Associate’s Degree or higher 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.

Responsibilities

• 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 DOFR.
• Maintains the member's right to privacy and protects SCAN operations by keeping information confidential.
• Ensures effective working relationships with providers by interacting in an appropriate, timely, professional manner, and promptly reporting any problems or issues.
• 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

Excellent communication

Organizational skills

Multitasking

Customer service

Professional demeanor

Education

High School Diploma or equivalent

Associate’s Degree preferred

Tools

MS Office

Job description

SCAN Health Insurance in California is seeking a dedicated Medical Management Associate to support provider calls, enter data into CCMS, and authorize services under clinical staff guidance.

You will handle claims processing data entry, verify eligibility, protect privacy, and maintain professional relationships with providers while adhering to quality standards. This remote role offers a base hourly rate and benefits.