About

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

• - Monday - Friday 8am-5pm
• - Pay: $20/hr
• -Medical, dental, and vision insurance offered
• -Supplemental insurance
• - 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 3 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