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

• Call Center

- Monday - Friday 8am-5pm

• Training pay: $18.50/hr after training pay $19.25/hr
• Medical, dental, and vision insurance offered
• Supplemental insurace
• 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 5 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