Medical Management Assistant (SCAN Temp)

Founded in 1977 as the Senior Care Action Network, SCAN began with a simple but radical idea: that older adults deserve to stay healthy and independent. Today, SCAN is a nonprofit health organization serving more than 500,000 people across Arizona, California, Nevada, New Mexico, Texas, and Washington, with over $8 billion in annual revenue. With nearly five decades of experience, we have built a distinctive, values-driven platform dedicated to improving care for older adults through Medicare Advantage, fully integrated care models, primary care, and next-generation care delivery.

About the role

This temporary remote role (approximately 3-6 months) supports the Medical Management department by responding to provider calls and faxes, entering inpatient and related data into the case management system (CCMS), authorizing SCAN services under the direction of clinical staff, and securing information to ensure the delivery of quality care and services to SCAN members.

Responsibilities

• Supports the authorization, monitoring, and processing of claims for inpatient and outpatient services by entering data into designated systems and triaging events per department guidelines.
• Maintains data entry requirements by following established workflows and departmental policies and procedures.
• Verifies member data by researching eligibility, participation in SCAN Care Management Programs, benefits, network provider status, contracts, and division of financial responsibility (DOFR).
• Maintains telephone standards by answering calls within established turnaround times.
• Serves as a resource for internal and external customers, ensuring services are provided within the benefit plan and utilizing contracted providers.
• Ensures effective working relationships with providers by interacting in a timely, professional manner and promptly reporting issues.
• Maintains member privacy and protects SCAN operations by keeping information confidential.
• Utilizes department desktop procedures, workflows, job aids, and training materials.
• Identifies barriers and escalates them to the supervisor/manager.
• Communicates effectively with members, caregivers, and representatives with courtesy and respect.
• Adheres to all quality, compliance, and regulatory standards to achieve HCS and SCAN outcomes.
• Contributes to team efforts by accomplishing related tasks as needed.
• Actively supports the achievement of SCAN’s vision and goals.
• Other duties as assigned.

Requirements

• High School Diploma or equivalent required; Associate’s Degree or equivalent experience preferred.
• 3+ years of medical experience in a managed care environment preferred.
• Proficiency with data entry required.
• ICD-9 and CPT coding experience preferred.
• Knowledge of medical terminology is required.
• Utilization Management experience is required.
• Excellent communication skills, primarily telephonic.
• Working knowledge of Medicare and Medi-Cal guidelines preferred.
• Strong organizational skills and the ability to prioritize.
• Ability to multitask and work with limited supervision.
• Ability to work well in a fast-paced and dynamic environment.
• Ability to provide professional customer service.
• Proficient in MS Office.

Benefits

• Base salary range: $20.14 to $27.77 per hour.
• Remote work mode.
• Annual employee bonus program.
• Robust Wellness Program.
• Generous paid-time-off (PTO).
• Eleven paid holidays per year, plus 1 additional floating holiday, plus 1 birthday holiday.
• Excellent 401(k) Retirement Savings Plan with employer match.
• Robust employee recognition program.
• Tuition reimbursement.

Schedule

Monday - Friday, 8:00 AM - 5:00 PM Pacific Time.