Care Management Support Coordinator II

Immediate need for a talented Care Management Support Coordinator II. This is a 12+ months (Contract to Hire ) opportunity with long-term potential and is located in San Jose, CA(Remote). Please review the job description below and contact me ASAP if you are interested.
 
Job ID:25-68238
 
Pay Range: $22 - $23/hour.  Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).
 
Key Requirements and Technology Experience:

• Key Skills:Medical Claims .
• Healthcare Insurance .
• Authorization/Prior-Auth .
• Requires a High School diploma or GED.
• Requires 1 – 2 years of related experience. 
• Knowledge of medical terminology and insurance preferred.
• Aids the utilization management team and maintains ongoing tracking and appropriate documentation on authorizations and referrals in accordance with policies and guidelines .
• Supports the authorization review process by researching and documenting necessary medical information such as history, diagnosis, and prognosis based on the referral to the clinical reviewer for determination .
• Verifies member insurance coverage and/or service/benefit eligibility via system tools and aligns authorization with the guidelines to ensure a timely adjudication for payment .
• Performs data entry to maintain and update various authorization requests into utilization management system .
• Supports and processes authorization requests for services in accordance with the insurance prior authorization list and routes to the appropriate clinical reviewer .
• Remains up-to-date on healthcare, authorization processes, policies and procedures.
• Performs other duties as assigned.
• Complies with all policies and standards.
• Claims experience, Health insurance experience (product knowledge).
• Billing experience, appeals. 

Our client is a leading Healthcare Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.
 
Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, colour, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

By applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy .

#prof J2W:CB3