Care Review Processor - CORRESPONDENCE PROCESSOR. (Remote – PST/MST)

We are looking to hire a candidate with the experience and skill sets mentioned for one of our major clients within the Health Insurance industry. This is a 3-month contract opportunity with the potential for extension (s). This is a REMOTE role.

 *This position is fully remote. Candidates must be able to work PST/MST hours. The schedule will be Tuesday – Saturday 10:00 am - 6:30 pm PST; Sunday - Thursday 10:00 am - 6:30 pm PST; Flex time- able to work late hours AND weekends.

Position Summary:

Works within the Care Access and Monitoring (CAM) team to provide clerical and data entry support for Molina Members who require hospitalization and/or utilization review for other healthcare services. Checks eligibility and verifies benefits, obtains, and enters data into systems, processes requests, and triages members and information to the appropriate Health Care Services staff to ensure the delivery of high quality, cost-effective healthcare services according to State and Federal requirements to achieve optimal outcomes for Molina Members.

Position Responsibilities:

• Data Entry (Intake) - enters information in system from fax system.
• Verifies eligibility, coverage, request for missing information, redirecting to in-network facilities.
• Assist in phone queue questions.
• Correspondence - Letter generation - selects a correct template, minor grammar checks.
• The Correspondence Processor (CP)is a non-clinical staff with a high school education and some experience in the medical field, preferably in managed care positions. The CP:• Processes and monitors all member and provider correspondence through the Molina Healthcare letter database• Adheres to UM policies and procedures.
• Respond to requests for authorization of services submitted to CAM via phone, fax, and mail according to Molina operational timeframes.
• Notify Care Access and monitor nurses and case managers of hospital admissions and changes in member status.
• Meet productivity standards. Maintain confidentiality and comply with the Health Insurance Portability and Accountability Act (HIPAA).
• Participate in Care Access and Monitoring meetings as an active member of the team.
• Meet attendance guidelines per Molina Healthcare policy.

Required Skills/Experience/Education:  

• Must have 2 years of experience in a Processesing and monitoring all member and provider, UM policies and procedures, Data Entry.
• Candidates MUST have Attention to detail, Fast learner, able to adapt to change, multi-tasking skills.
• Previous, Correspondence- Letter generation- selects correct template, minor grammar checks.
• Computer skills and experienced user of Microsoft Office software.
• Accurate data entry at 40 WPM minimum.
• Demonstrated ability to communicate, problem-solve, and work effectively with people..
• Good communication and interpersonal/team skills..
• Able to work independently and as part of a team.
• Attention to detail, Fast learner, able to adapt to change, and multi-tasking skills are a MUST.
• High School Diploma/GED Required. High School Graduate (CRP); Some College (Correspondence Processor).
• Required/Provided Equipment: A laptop, keyboard, mouse, and headset will be required for this candidate to be successful in this role, and 2 monitors in addition to the laptop.

Other job specifications:

• Employment Type: Contract to Hire (CTH), W2 only. NO C2C.
• Contracting Period: 3-month contracting opportunity with potential for extension (s).
• Job Location: The position is fully remote. Candidates in the PST/MST time are highly preferred. 

• The Schedule: Will be Tuesday – Saturday 10:00 am - 6:30 pm PST; Sunday - Thursday 10:00 am - 6:30 pm PST; Flex time- able to work late hours AND weekends.
• Contract Rate/Salary: $19/hr. on W2.
• Interview Process: Teams Meeting/Video Interview (1 interview).