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Care Review Processor I

Icon Information Consultants

Orlando, FL(remote)

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JOB DETAILS
SALARY
SKILLS
Administrative Skills, CAD/CAM (Computer-Aided Design/Computer-Aided Manufacturing), Certified Case Manager (CCM), Clinical Information, Clinical Study Publications, Communication Skills, Current Procedural Terminology (CPT), Customer Support/Service, Data Entry, Documentation, HIPAA (Health Insurance Portability and Accountability Act), Health Insurance, Healthcare, Healthcare Administration, Healthcare Common Procedure Coding System (HCPCS), Healthcare Providers, High School Diploma, Hospital, Hospital Administration, ICD-10, ICD-9, Information/Data Security (InfoSec), Maintain Compliance, Managed Care, Medicaid, Medical Billing, Medical Office, Medical Terminology, Microsoft Office, Multitasking, Organizational Skills, Patient Admissions, Patient Confidentiality, Utilization Management
LOCATION
Orlando, FL
POSTED
1 day ago
Care Review Processor

Key Details
  • Location: Fully Remote (Any approved Molina state; must work EST hours)
  • Duration: 6-month contract (potential to extend)
  • Schedule: Monday-Friday, 9:30 AM-6:00 PM EST or 10:30 AM-7:00 PM EST
  • Hours: 40 hours per week
  • Work Arrangement: Remote
  • Compensation: $25.00/hour
  • Employment Type: W2 (not open to C2C, 1099, or visa sponsorship)
Role Overview

Our client is seeking a Care Review Processor to join the Care Access and Monitoring (CAM) team. This role provides administrative and data entry support for utilization management activities involving hospitalized members and healthcare service reviews. The ideal candidate has prior utilization management or health insurance experience, is comfortable working in a fast-paced healthcare environment, and possesses strong customer service, medical terminology, and data entry skills.

Key Responsibilities
  • Process incoming authorization requests received via phone, fax, and mail
  • Verify member eligibility, benefits, provider participation, and coordination of benefits (COB)
  • Create and update authorizations within Molina systems
  • Process inbound and outbound calls with providers and healthcare facilities
  • Review diagnosis and treatment requests using medical terminology
  • Assign or verify ICD-9, ICD-10, CPT, and HCPCS billing codes
  • Verify inpatient admissions, discharges, and hospital census information
  • Contact physician offices to obtain missing documentation or additional clinical information
  • Notify nurses and case managers of hospital admissions and member status changes
  • Maintain accurate documentation while meeting quality and productivity standards
  • Ensure HIPAA compliance and confidentiality of protected health information (PHI)
  • Participate in team meetings and collaborate across departments to support continuity of care
Required Qualifications
  • High School Diploma or GED
  • 0-2 years of experience in Utilization Management, Utilization Review, or Managed Care
  • Previous experience in a medical office, hospital, healthcare administration, medical billing, or healthcare clerical role
  • Experience working with health insurance processes
  • Knowledge of medical terminology
  • Proficiency with Microsoft Office
  • Accurate data entry skills (40+ WPM)
  • Strong communication, organizational, and customer service skills
  • Ability to multitask in a fast-paced environment while maintaining confidentiality
Preferred Qualifications
  • Managed Care or Medicaid experience
  • Previous authorization processing experience
  • Experience working with utilization management systems

About the Company

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Icon Information Consultants