1 Position at our Rocklin, CA Location
Summary
The Managed Care Assistant I is a non-supervisory position that coordinates all managed care/medical bill review/MPN/reporting and other support related activities across the InterMed organization. This non-clinical position to assist and support the Bill Review and Managed Care staff by performing general and administrative tasks.
Essential Duties and Responsibilities
- Screen referrals received from claims examiner for attached medical report prior to assignment to a Utilization Review Nurse (clinical), under direction of supervisor.
- Contact doctor offices & other health care disciplines involved in the care of injured workers to obtain current medical reports, orders & work status; adhering to call script.
- Responsible for maintaining a daily diary.
- Data entry in electronic claim file, sharefile, and Managed Care system.
- Format and document letters or correspondence according to documentation process standards as directed.
- Generate and format letters from the electronic claim file as directed.
- Create and submit referrals to vendor partners or client vendors when necessary.
- Participate in ongoing training/professional development.
- Answer phone calls related to utilization review, nurse case management, bill review, and medical provider networks.
- Refer all clinical related questions or issues to licensed staff, analysts, or Supervisor/Managers.
- Data entry for indexing which requires identifying claim numbers, payees, ICD codes and dates of service.
- Assist in researching claim numbers and locating bills in the system.
- Print and mail Zero EORs
- Be aware of potential compromise in a patient’s safety. Refer to proper authority.
- Uses plain language to communicate (written and verbal) with injured workers, claims examiners, and clients.
- All other non-clinical related tasks as assigned by clinical staff and leadership staff
Qualification Requirements
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education and/or Experience
High school diploma or general education degree (GED); some knowledge of California Worker’s Compensation and medical terminology preferred. One to three months related experience and/or training; or equivalent combination of education and experience preferred.
