Medical Management Specialist - Remote to Indiana

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Description BKG Enterprises is seeking Medical Management Specialist to join our team! This is a work-from home opportunity! • Call Center - Monday - Friday 8am-5pm • Training pay $18.50/hr after training pay $19.25/hr • Medical, dental, and vision insurance offered • Supplemental insurace • 80 hours of PTO after 90 days • 10 paid holidays Responsible for providing non-clinical support to medical management operations calls, which includes handling the most complex file reviews and inquiries from members and providers. Primary duties may include but are not limited to • Gathers clinical information regarding case and determines appropriate area to refer or assign case (utilization management, case management, QI, Med Review). • Conducts initial review of files to determine appropriate action required. • Maintains and updates tracking databases. • Prepares reports and documents all actions. • Responds to requests, calls or correspondence within scope. • Provides general program information to members and providers as requested. • May review and assist with cases. • May collaborate with external community-based organizations to facilitate and coordinate care under the direction of an RN Case Manager. • Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical information. • Acts as liaison between medical management operations and other internal departments to support ease of administration of medical benefits. Provides mentoring and work direction to lower-level associates. Requirements • Requires a high school diploma and a minimum of 5 years administrative and customer service experience; or any combination of education and experience which would provide an equivalent background. Knowledge of managed care or Medicaid/Medicare concepts strongly preferred. • Position requires strong customer service/call center skills Apply To This Job

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