AppleCare Medical Management Group was incorporated in 2003. Over the last 17 years, the multispecialty medical group of independent practices has expanded into new communities, contracted with more hospitals and health plans, and added over 50 new doctors - but the mission has remained the same. Today, AppleCare Medical Management is comprised of hundreds of board - certified private - practice, independent physicians. Collectively, our physicians have been serving the Southeast area of Los Angeles and Northern Orange County for decades, providing their medical expertise and passion to improving the health of our communities. Talk about meaningful work. Talk about an important role. Let's talk about your next career move. Due to our expanding business, we are seeking a Part-time Case Coordinator who shares our passion for helping others live healthier lives. This is a Work from Home / Telecommute position! *** The schedule for this job is 4:00pm to midnight or midnight to 8:00am on Saturdays and Sundays*** Primary Responsibilities: Manage administrative intake of members or the admission/discharge information post notification Work with hospitals, clinics, facilities and the clinical team to manage request for services from members and / or providers Manage the referrals process, processing incoming and outgoing referrals, and prior authorizations, including intake, notification and census roles Receive care coordination notification cases for non - clinical assessment / intervention and provide appropriate triage Review requests for adverse determination, approval notification and processing notification requirements Assist the clinical staff with setting up documents / triage cases for Clinical Coverage Review Handle resolution/inquiries from members and/or providers that may include: Benefit and Eligibility information Billing and Payment issues Customer material requests Physician assignments Authorization for treatment Explanation of Benefits (EOB) Verifying appropriate ICD - 9 and CPT coding usage
Required Qualifications:Ability to work from 4pm to midnight or midnight to 8am on Saturdays and Sundays (work from home role!) HS Diploma or GED 1+ years of experience in managed care environment or medical office or clinic setting Knowledge of UM / QM processes and principles Knowledge of training and audit principles and processes Knowledge of and experience with medical coding Knowledge of general IPA operations Preferred Qualifications:Bilingual Spanish speaking Computer literate in Microsoft Word and Excel Knowledge of medical terminology Strong ability to work effectively with nurses, physicians and other clinical and operational staff, both written and verballyAs one of the world's leading health care companies, UnitedHealth Group is pursuing innovative new ways to operate our service centers and improve on our ability to deliver high - quality care. As part of our clinical support team, you will be a key component in customer satisfaction and have a responsibility to make every contact informative, productive and positive for our members and providers. You'll have the opportunity to do live outreach, educating members about program benefits and services while also helping to manage member cases. Bring your skills and talents to a role where you'll have the opportunity to make an impact on a huge scale. Take this opportunity and begin doing your life's best work.(sm) What makes your clinical career greater with UnitedHealth Group? You'll work within an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere. Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Job Keywords: Case Coordinator, La Palma, CA, California
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.