Medical Management Assistant

Quartz is seeking detail oriented, well organized individual to support our Utilization Management team as a Medical Management Assistant.

This role will work with in the NCQA requirements for completion and turn-around times for requests and cases and assists with adherence to processes, making determinations based on policies/procedures in effect within the department and referring the next level of review when appropriate.

This position will also provide detailed customer service to patients, providers and clinic staff regarding pre-service, concurrent and post-service requests with documentation in appropriate systems or databases.

• Full-time, remote work environment available
• Work schedule an 8-hour schedule between the hours of 8:00am – 5:00pm, Monday – Friday
• Starting pay range: $21 - $26.45\hr.
• Provides appropriate notification to nursing staff of all requests and hospitalizations requiring further review
• Makes approval determinations according to written protocols and guidelines as appropriate. Refers any medical questions or potential denial determinations to nursing staff for further review.
• Assists in the medical review process for referrals, prior authorizations, inpatient reviews and claims reviews by obtaining appropriate supporting information and documentation to assist in making necessity and benefit determinations as well as reconsiderations.
• Provides telephone customer service for members, providers, and other Health System or Quartz staff regarding authorization requests, hospitalizations and claim questions.
• High school diploma or equivalent
• 1+ year of experience working in a healthcare environment, such as claims processing, medical billing/insurance claims, or related experience
• Experience with computer applications such as MS Office and/or Epic
• Prior data entry and word processing experience is preferred
• Great attention to detail and excellent organizational skills
• Excellent oral and written communication skills, including phone skills
• Knowledge of medical terminology; previous experience in a medical office or medical field is preferred