Experienced Medical Management Professional for Phone Queue Operations – Remote Role

Join SCAN Group, a Pioneer in Senior Healthcare, as a Medical Management - Phone Queue Specialist SCAN Group, a not-for-profit organization dedicated to improving the lives of older adults in the United States, is seeking a highly skilled and experienced Medical Management professional to join our team as a Phone Queue Specialist. This 100% remote role offers a unique opportunity to work with a leading expert in senior healthcare, driving success and making a meaningful difference in the lives of our members. About SCAN Group With over 45 years of experience in senior healthcare, SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation's leading not-for-profit Medicare Advantage plans. We serve over 277,000 members across California, Arizona, Nevada, Texas, and New Mexico. Our team of passionate professionals is committed to supporting older adults on their aging journey, innovating healthcare for seniors everywhere. At SCAN, we pride ourselves on providing in-depth training, state-of-the-art tools, and opportunities for growth and development. The Role: Medical Management - Phone Queue Specialist This critical role supports the Medical Management department at SCAN by responding to provider calls and faxes, entering inpatient and related data into the case management system (CCMS), authorizing SCAN services under the direction of clinical staff, and supporting the Medical Management clinical staff in securing information needed to ensure the delivery of quality care and services to SCAN members. Key Responsibilities:

• Supports the authorization, monitoring, and processing of claims for inpatient and outpatient services by entering data into designated systems and triaging events per department guidelines.
• Maintains data entry requirements by following established workflows and departmental policies and procedures.
• Verifies member data by researching eligibility, member participation in SCAN Care Management Programs, benefits, network provider status, contracts, and division of financial responsibility (DOFR).
• Maintains telephone standards by answering calls within established turnaround times.
• Serves as a resource for internal and external customers by ensuring services are provided within the benefit plan and utilizing contracted providers.
• Ensures effective working relationships with providers by interacting in an appropriate, timely, professional manner and promptly reporting any problems or issues.
• Maintains the member's right to privacy and protects SCAN operations by keeping information confidential.
• Utilizes department desktop procedures, workflows, job aids, and training material to identify barriers and bring them to the attention of the supervisor/manager.
• Communicates effectively with members by providing appropriate and timely information and showing courtesy and respect to each member, their caregivers, and/or representatives.
• Adheres to all quality, compliance, and regulatory standards to achieve HCS and SCAN outcomes.
• Actively supports the achievement of SCAN's Vision and Goals.

Essential Qualifications:

• 3+ years of medical experience in a managed care environment (preferred).
• Proficiency with data entry required.
• Knowledge of medical terminology is required.
• Utilization Management Experience Is Required.
• Excellent communication skills, primarily telephonic, required.
• Strong organizational skills and the ability to prioritize.
• Ability to multitask and work with limited supervision.
• Ability to work well in a fast-paced and dynamic environment.
• Ability to provide professional customer service.

Preferred Qualifications:

• ICD-9, CPT Coding Experience.
• Working knowledge of Medicare and Medi-Cal guidelines.

What We Offer

At SCAN Group, we believe in rewarding our employees for their hard work and dedication. As a Medical Management - Phone Queue Specialist, you can expect:

• A competitive base salary range of $20.14 to $32.21 per hour.
• A remote work arrangement, working Monday to Friday, 9 am to 6 pm Pacific Time.
• An annual employee bonus program.
• A robust Wellness Program.
• Generous paid-time-off (PTO).
• Eleven paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday.
• An excellent 401(k) Retirement Saving Plan with employer match and contribution.
• A robust employee recognition program.
• Tuition reimbursement.
• Opportunities for growth and development within a dynamic organization.

Our Culture and Values At SCAN Group, we are committed to creating a workforce that reflects our community through inclusive programs and initiatives. We believe in driving Equality in our communities and workplaces, with a focus on equal pay, employee resource groups, inclusive benefits, and more. We are proud to be an Equal Employment Opportunity and Affirmative Action workplace, where individuals seeking employment will receive consideration without regard to race, color, national origin, religion, age, sex, sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status, or any other status protected by law. Join Our Team If you are a motivated and experienced Medical Management professional looking for a challenging and rewarding role, we encourage you to apply for this exciting opportunity. As a Medical Management - Phone Queue Specialist at SCAN Group, you will be part of a team that is making a difference in the lives of our members and our community every day. Don't miss out on this chance to join our team and be part of something meaningful. Apply now and take the first step towards a fulfilling career with SCAN Group! Apply This Job Apply tot his job Apply To this Job