Care Review Processor

JOB DESCRIPTION Job Summary Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service. KNOWLEDGE/SKILLS/ABILITIES • Provides telephone, clerical, and data entry support for the Care Review team. • Provides computer entries of authorization request/provider inquiries, such as eligibility and benefits verification, provider contracting status, diagnosis and treatment requests, coordination of benefits status determination, hospital census information regarding admissions and discharges, and billing codes. • Responds to requests for authorization of services submitted via phone, fax, and mail according to Molina operational timeframes. • Contacts physician offices according to Department guidelines to request missing information from authorization requests or for additional information as requested by the Medical Director. Job Qualifications Required Education HS Diploma or GED Required Experience 1-3 years’ experience in an administrative support role in healthcare. Preferred Education Associate degree Preferred Experience 3+ years’ experience in an administrative support role in healthcare, Medical Assistant preferred. Candidates from these areas preferred: Alabama Arizona Arkansas Colorado Delaware Florida Georgia Idaho Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Mississippi Missouri Montana Nebraska New Hampshire New Jersey New Mexico North Carolina North Dakota Ohio Oklahoma Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Apply Job!