Care Review Processor (PST or CST Hours)

Molina Healthcare • Kenosha, WI • 5h ago

Molina Healthcare is hiring several Care Review Processors. These roles are remote and can be worked in a variety of states within the US.

Highly qualified candidates will have the following:

Healthcare knowledge or background either clinical (Medical Assistant) or in an administrative capacity

Experience working in a fast paced, high-volume environment with priorities that may change

High level critical thinking skills

Above average computer skills

Adaptability and attention to detail

Ability to work either 830am-530 pm Monday through Friday or Tuesday through Saturday.

Job Summary

Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE/SKILLS/ABILITIES

Provides telephone, clerical, and data entry support for the Care Review team.

Provides computer entries of authorization request/provider inquiries, such as eligibility and benefits verification, provider contracting status, diagnosis and treatment requests, coordination of benefits status determination, hospital census information regarding admissions and discharges, and billing codes.

Responds to requests for authorization of services submitted via phone, fax, and mail according to Molina operational timeframes.

Contacts physician offices according to Department guidelines to request missing information from authorization requests or for additional information as requested by the Medical Director.

Required Education : HS Diploma or GED

Preferred Education : Associate Degree

Required Experience : 1-3 years' experience in an administrative support role in healthcare.

Preferred Experience : 3+ years' experience in an administrative support role in healthcare, Medical Assistant preferred.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers competitive benefits and compensation packages. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Same Posting Description for Internal and External Candidates

Pay Range: $21.16 - $31.71 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

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