5 medical assistant i jobs found

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Responsible for answering member, provider & broker inquiries pertaining to product information, benefits, claims resolution, eligibility and billing questions in a call center environment. Proactively provides information and education to members, providers & brokers, as appropriate, about a variety of health, financial, and self-service programs. Provides basic technical assistance and troubleshooting guidance for digital and electronic applications. ESSENTIAL FUNCTIONS: Provides first- level problem resolution to member, provider & broker inquiries via telephone by gathering and researching information; examine claim submissions verifying claim and system accuracy as well as liability, validate customer understanding of information and resolves issues based on applicable policies and procedures. Uses knowledge of products and the contractual provisions that govern administration to...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Supports Pharmacy Quality clinical teams by assisting with non-clinical administrative tasks and responsibilities related to care coordination, member outreach, and provider/pharmacy engagement to improve Quality measure performance related to Pharmacy. We are looking for an experienced professional to work remotely from within the greater Baltimore metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business related activities. Although this position is REMOTE, candidates are preferred to live in the MD, DC, VA area in order to travel into our local offices on occasion. ESSENTIAL FUNCTIONS: Assists with member follow up and coordination of care that does not require intervention from a clinician (refilling prescriptions, finding appointments, calling providers and pharmacies, arranging services, etc.), enabling...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: This position supports the clinical teams by handling non-clinical tasks related to preauthorization functions, inpatient care, utilization review, care coordination and/or quality of care, enabling clinical staff to perform at the top of their license. ESSENTIAL FUNCTIONS: Provides ongoing internal and external customer support for operational inquiries from members, providers and/or other customers including benefit verification, authorization creation and management, claims inquiries and/or case documentation. Assists with member follow up and coordination of care that does not require intervention from a clinician including post-discharge monitoring, appointments and/or arranging services, enabling clinicians to work at full capacity. Reviews authorization requests for initial determination and/or triages for clinical review and resolution. Screens, and/or prioritizes members using targeted...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: This position supports the clinical teams by handling non-clinical tasks related to preauthorization functions, inpatient care, utilization review, care coordination and/or quality of care, enabling clinical staff to perform at the top of their license. ESSENTIAL FUNCTIONS: Provides ongoing internal and external customer support for operational inquiries from members, providers and/or other customers including benefit verification, authorization creation and management, claims inquiries and/or case documentation. Assists with member follow up and coordination of care that does not require intervention from a clinician including post-discharge monitoring, appointments and/or arranging services, enabling clinicians to work at full capacity. Reviews authorization requests for initial determination and/or triages for clinical review and resolution. Screens, and/or prioritizes members using targeted...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Paralegal III position is an advanced position for an experienced paralegal with subject matter expertise in a designated specialty area of the law, such as litigation (plaintiff and/or defense), with a focus on regulatory, compliance and employment law, providing advanced support to the attorneys in the organization and to other Divisions or Departments as directed by counsel. ESSENTIAL FUNCTIONS: Work in Specialized Area of Expertise: Proactively, monitor and manage compliance with statutory and regulatory requirements in the area of expertise, including investigating and researching complex legal matters, collecting and compiling information and documents and either timely responding to, or proposing draft responses to legal correspondence for counsels final review. Draft documents, including proposing responsive pleadings or other legal documents for counsel, compile, update, and manage all...