Senior Care Review ProcessorMolina Healthcare Richmond, Virginia Job ID 2010407
Works with physicians and multidisciplinary team members to develop a plan of care for each assigned patient from admission through discharge. Assesses members for care needs, and develops treatment plan with practitioners, providers, members and support system. Ensures quality member care is provided. Ensures patient is progressing towards desired outcomes by continuously monitoring patient care through assessments and/or evaluations. Assesses and responds to patient/family needs by coordinating efforts of other team members. Identifies and resolves barriers that hinder effective patient care. May coordinate for medical service/appointments once discharge is complete and make the necessary community resource referrals.
• Provides computer entries of authorization request/provider inquiries by phone, mail, or fax. Including: eligibility and benefits verification, provider contracting status, and diagnosis and treatment requests.
• Provides the following additional data entry: Coordination of Benefits status determination, hospital census information regarding admissions and discharges, and billing codes.
• Responds to requests for authorization of services submitted via phone, fax and mail according to Molina operational timeframes.
• Participates in interdepartmental integration and collaboration to enhance the continuity of care for Molina members including Behavioral Health and Long Term Care.
• Contacts physician offices according to Department guidelines to request missing information from authorization requests or for additional information as requested by the Medical Director..
Associate's Degree or equivalent combination of education and experience
Bachelor's Degree or equivalent combination of education and experience
Preferred License, Certification, Association
Certification in Coding, auditing or billing
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.Job Type: Full Time Posting Date: 09/23/2021