Care Review Processor-PST times (Remote)

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. Must have: Medical terminology ICD 10 code knowledge CPT code knowledge IPA or health plan UM experience(Prior authorization or Inpatient) 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. 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!