Medical Management Specialist
2 days ago
We are seeking a highly skilled Medical Management Specialist to join our team at HMSA. As a key member of our healthcare operations team, you will be responsible for evaluating, interpreting, and processing clinical review requests in accordance with accreditation and governmental regulation requirements.
Key Responsibilities- Validate clinical review requests to ensure they meet submission requirements and regulatory requirements.
- Educate and communicate with provider offices on appropriate procedures and policies.
- Apply internal policies, contractual provisions, and regulatory requirements to ensure accurate and timely processing of clinical review requests.
- Utilize various resources to confirm HMSA's clinical review requirements and educate provider offices accordingly.
- Process vendor authorization files to reflect accurate decisions within HMSA's system.
- Resolve, document, and respond to inquiries, issues, or complaints received from providers and members.
- Monitor and process clinical review requests received via online authorization tool.
- Strong knowledge of healthcare operations, clinical review processes, and regulatory requirements.
- Excellent communication and interpersonal skills.
- Ability to work in a fast-paced environment and prioritize multiple tasks.
- Proficiency in utilizing various resources and systems to confirm clinical review requirements.
What We Offer
HMSA offers a competitive salary, comprehensive benefits package, and opportunities for professional growth and development.
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