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Medical Management Specialist - Remote to Indiana

Professional Management Enterprises
Indianapolis, IN Remote Full Time
POSTED ON 1/23/2025 CLOSED ON 2/16/2025

What are the responsibilities and job description for the Medical Management Specialist - Remote to Indiana position at Professional Management Enterprises?

Description

BKG Enterprises is seeking Medical Management Specialist to join our team! This is a work-from home opportunity!


- Monday - Friday 8am-5pm

- Pay: $18.50/hr 

-Medical, dental, and vision insurance offered

-Supplemental insurance

- 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 3 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

Salary : $18 - $19

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