Medical Management Assistant

About the role

Quartz is seeking a detail-oriented, well-organized individual to support our Utilization Management team. This role ensures compliance with NCQA requirements for completion and turn-around times for requests and cases, assists with adherence to processes, and makes determinations based on departmental policies and procedures. The position provides detailed customer service to patients, providers, and clinic staff regarding pre-service, concurrent, and post-service requests with documentation in appropriate systems or databases.

Responsibilities

• 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.

Requirements

• 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.
• General knowledge of NCQA requirements is preferred.
• Must have access to high-speed internet for remote work.

Schedule

Full-time, 8-hour schedule between the hours of 8:00 AM – 5:00 PM, Monday – Friday.

Pay

Starting pay range: $21 - $26.45 per hour.

Benefits

• Full-time, remote work environment available (in-person or hybrid options in Madison, WI or Onalaska, WI).
• Hardware and equipment provided by the company.
• Competitive compensation and an excellent benefit package.
• Professional culture built on the foundations of Respect, Responsibility, and Relationships.