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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in data entry and customer service within a healthcare setting, with a strong understanding of ICD 10 and CPT codes. Proficient in utilizing medical management systems and ensuring compliance with regulatory requirements.
Highest-signal resume keywords
Data Entry Specialist ExperienceUtilization Management KnowledgeICD 10 and CPT Code KnowledgeCustomer Service SkillsMedical Management System Proficiency
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Data EntryUtilization ManagementICD 10 CodingCPT CodingMedical Management System Proficiency
Soft Skills
Customer ServiceCollaborationCommunicationProfessionalismTeamwork
Tools & Technologies
Right Fax ServerEDI InterfaceElectronic Medical RecordWord Processing ApplicationsDatabasesSpreadsheets
Certifications & Qualifications
High School DiplomaGED
Industry Keywords
HMOManaged CareHealthcare DeliveryHEDISCare Coordination
About the role
Key responsibilities & impact- Ensure all face sheets are complete and accurate with current member demographic information
- Monitor the Right Fax server, EDI Interface, and medical management system to process intake timely
- Review daily census reports and eliminate duplicates or unnecessary admissions
- Verify eligibility and assign authorization to the appropriate NRP nurse based on the Far tool
- Attach reviews and orders into the medical management system for NRP nurse review
- Obtain member discharge dates through calls, Electronic Medical Record review, or memo submissions
- Process program referrals and member discharges timely
- Contact providers by phone, fax, or email to request additional medical information
- Communicate with providers and facilities regarding program referrals, orders, and clinical reviews
- Assist NRP Nurses with care coordination for members with care management conditions
- Set up hospital follow-up appointments and provide details to members
- Document call interactions in the medical management system
- Collaborate with internal teams on member care issues and consult with Hospital & Ancillary Department Leadership
- Assist with identifying HEDIS gaps and conducting member outreach
- Ensure documentation complies with regulatory requirements and accreditation standards
- Support workflow improvements and department initiatives
- Perform other duties required to support health plan operations and department needs
Requirements
What you’ll need- Minimum of two (2) years of experience as a data entry specialist in a customer service-oriented environment
- Data entry specialist experience preferably in an HMO or Managed Care setting
- Utilization Management experience preferred
- High School Diploma or GED required
- Knowledge of ICD 10 and CPT codes
- Knowledge of utilization management in a health care delivery setting preferred
- Skilled with computer applications, including word processing, databases, and spreadsheets
- Good customer service skills
- Ability to meet performance measurement standards for productivity and accuracy
- Ability to represent the organization in a friendly and professional manner while answering calls
- Ability to promote a positive and collaborative working environment within the team
- Ability to participate in scheduled meetings
Benefits
Comp & perks- Competitive salary
- State of the art fitness center on-site
- Medical Insurance with Dental and Vision
- Life, short-term, and long-term disability options
- Career advancement opportunities and professional development
- Wellness programs that promote a healthy work-life balance
- Flexible Spending Account – Health Care/Childcare
- CalPERS retirement
- 457(b) option with a contribution match
- Paid life insurance for employees
- Pet care insurance