Care Review Processor

Welcome to Molina Healthcare! We are currently seeking a motivated and detail-oriented individual to join our team as a Care Review Processor. In this role, you will be responsible for reviewing and processing medical claims and requests for services to ensure compliance with Molina's policies and procedures. Our ideal candidate will have a strong understanding of healthcare regulations and possess excellent analytical skills. If you are looking for a challenging and rewarding career in the healthcare industry, we encourage you to apply for this exciting opportunity. Keep reading to learn more about the qualifications we are looking for in our Care Review Processor.

1. Review and process medical claims and requests for services in accordance with Molina's policies and procedures.
2. Ensure compliance with all applicable healthcare regulations, including but not limited to HIPAA and CMS guidelines.
3. Utilize strong analytical skills to accurately assess and determine the validity of medical claims and requests for services.
4. Communicate effectively with healthcare providers and internal team members to gather necessary information and resolve any discrepancies.
5. Maintain a high level of attention to detail to ensure accurate and complete documentation of all processed claims and requests.
6. Adhere to strict deadlines and productivity standards while maintaining a high level of accuracy and quality.
7. Collaborate with other departments within Molina to identify and resolve potential issues and improve processes.
8. Stay updated on industry trends and changes in healthcare regulations to ensure compliance and efficiency in claim processing.
9. Provide excellent customer service to both internal and external stakeholders, addressing any inquiries or concerns in a timely and professional manner.
10. Take ownership of assigned tasks and proactively seek solutions to problems that may arise during the claim processing process.
11. Participate in ongoing training and development to enhance knowledge and skills related to the role.
12. Maintain confidentiality and handle sensitive information in accordance with company policies and procedures.
13. Contribute to a positive and collaborative team environment by actively sharing knowledge and providing support to team members.
14. Represent Molina Healthcare in a professional and ethical manner at all times.

According to JobzMall, the average salary range for a Care Review Processor is $30,000 to $50,000 per year. The salary may vary depending on factors such as location, experience, and employer. Some employers may also offer benefits such as health insurance, retirement plans, and paid time off.

Molina Healthcare is a managed care company headquartered in Long Beach, California, United States. The company provides health insurance to individuals through government programs such as Medicaid and Medicare.