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About this job

Serves as initial point of contact for providers and members in the medical management process by telephone or correspondence. Assists in ensuring members are effectively and efficiently managed through the medical/disease management process as needs require. Within extension of authority, assigns length of stay on acute inpatient admissions, as well as approves specific home health, DME. Process authorization requests and facilitates referrals. Assists with system letters, requests for information and data entry. Provides administrative/clerical support to medical and disease management.

Day to Day Responsibilities of this Position and Description of Project:
Review and process Provider Data Modifications forms (PDMF) for addition, changes and deletions in MHC. Review and process Electronic Provider Data Changes (EPDC) for addition, changes and deletions in MHC. Assist with other Data Maintenance activities, as required for Annual provider directory updates, loading new IPA roster and quarterly roster verification. Conduct thorough follow-up and effective resolution to claims, UM and provider inquiries and requests. Assist to investigate and correct provider data errors from L.A. Care upload - Master Provider Database(MPD) and PCP confirmation Submission. Assist in reviewing and process hospital affiliation in MHC databases to allow for UM activities. Assist in clearing provider claims issues and finance returned address check.




About Aerotek:

Our people are everything. As a Best of Staffing® Client and Talent leader, Aerotek® Inc. has distinguished itself as a leader in recruiting and staffing services, by having a deep understanding of the intersection of talent and business. As a strategic partner to more than 17,000 clients and 300,000 contract employees every year, Aerotek's people-focused approach yields competitive advantages for its clients and rewarding careers for its contract employees. Headquartered in Hanover, Md., Aerotek operates a network of over 230 non-franchised offices with more than 6,000 internal employees dedicated to serving our customers. Aerotek is an operating company of Allegis Group, a global talent solutions provider. To learn more, visit .

Aerotek is acting as an Employment Agency in relation to this vacancy.