Pay Range:$22/hr-$25/hr

About the Role

• We are seeking a dedicated individual to join our Care Access and Monitoring (CAM) team.
• This role involves providing clerical and data entry support for members requiring hospitalization or utilization review for healthcare services.
• The position requires living in California and offers varied schedules from Sunday to Saturday. The role necessitates the use of dual monitors and a docking station.

Responsibilities

• Enter authorization requests and provider inquiries into the system via phone, mail, or fax.
• Verify member eligibility and benefits, determine provider contracting status, and assess diagnosis and treatment requests.
• Assign appropriate billing codes (ICD-9/ICD-10 and/or CPT/HCPC codes) and determine COB status.
• Verify inpatient hospital census, including admissions and discharges.
• Respond to service authorization requests according to operational timeframes. 
• Collaborate with interdepartmental teams to enhance continuity of care, including Behavioral Health and Long Term Care.
• Contact physician offices for missing or additional information as needed.
• Provide excellent customer service to both internal and external customers.
• Meet department quality standards and productivity benchmarks.
• Notify Care Access and Monitoring Nurses and case managers of hospital admissions and changes in member status.
• Maintain confidentiality and comply with HIPAA regulations.
• Participate actively in Care Access and Monitoring meetings.
• Adhere to attendance guidelines and workplace safety standards.

Education Qualification

• High School Diploma or GED

Required Skills

• Demonstrated ability to communicate, problem-solve, and work effectively with others.
• Working knowledge of medical terminology and abbreviations.
• Strong analytical and problem-solving skills. 
• Excellent communication and interpersonal skills.
• High regard for confidential information.
• Ability to work in a fast-paced environment, independently and as part of a team.
• Proficient in MS Office software.
• Accurate data entry skills with a minimum of 40 WPM.

Must Have Experience

• 2-4 years of experience in a Utilization Review Department within a Managed Care Environment.
• Previous experience in hospital or healthcare clerical, audit, or billing roles.
• Familiarity with medical terminology.

The Company offers the following benefits for this position, subject to applicable eligibility requirements: medical insurance, dental insurance, vision insurance, 401(k) retirement plan, life insurance, long-term disability insurance, short-term disability insurance, paid parking/public transportation, paid time off, paid sick and safe time, hours of paid vacation time, weeks of paid parental leave, and paid holidays annually – as applicable.