Medical Assistant Admin

Description: Responsible for the intake of information regarding the authorization of services for members of all product lines, including communication to the case managers. Works with the PCP, the member and management to promote the delivery of quality services at the most appropriate and cost-effective setting. Monitors members’ utilization patterns for identification of high-risk and under and over use of services. Clarifies benefits for providers.

MUST HAVE EXPERIENCE WITH:

1. Intake and processing of authorizations for outpatient medical services for assigned product line(s).

2. Intake and processing of authorization of inpatient facility admissions for assigned product line(s), including concurrent review to facilitate discharge planning.

3. Reviews all utilization for the most cost-effective delivery.

4. Monitors member's utilization patterns

Qualifications:

• High School diploma or equivalent (this will need to be presented in onboarding)
• Two (2) years experience working in a medical practice office, an urgent care, hospital, skilled nursing facility or other health care setting and completion of a medical-related training program such as Medical Assistant, EMT or Nursing Assistant.