Archived listing. The details below describe a past opening.
We are looking for a detail-oriented Data Entry Clerk to support utilization management operations for a healthcare organization in Westminster, California. This Long-term Contract position focuses on maintaining accurate records, coordinating authorization-related information, and helping ensure service requests move through the review process on time. The role works closely with internal teams, providers, and members to gather documentation, update case information, and support compliance with healthcare guidelines.
Responsibilities:
- Enter, update, and maintain authorization and member-related information with a high level of accuracy across designated systems.
- Communicate with healthcare providers and members by phone to clarify request status, obtain missing details, and relay documentation needs.
- Track pending service requests and follow established timelines to help meet required turnaround standards.
- Review incoming records for completeness, organize supporting documents, and attach files to the appropriate cases.
- Assist with the preparation and processing of determination correspondence, including approval and denial notifications.
- Maintain daily logs, status reports, and related records to support visibility into authorization activity and workload.
- Identify urgent, sensitive, or complex cases and route them promptly to nurses or medical directors for clinical review.
- Support audit readiness by ensuring files are properly documented and aligned with organizational, state, and contractual expectations.
- Participate in team meetings, training sessions, and other departmental activities while assisting with additional administrative tasks as needed.
- Associate degree or equivalent practical experience required.
- At least 2 years of experience in managed care, health plan administration, prior authorization support, or a healthcare office environment.
- Working knowledge of authorization processes and time-sensitive service request handling.
- Strong data entry and typing skills, including accurate entry of numeric and text-based information.
- Proficiency with Microsoft Office applications and the ability to learn utilization management or healthcare documentation systems.
- Excellent organizational skills with the ability to manage a high volume of detailed tasks efficiently.
- Clear written and verbal communication skills and the ability to follow up on incomplete submissions.
- Bilingual ability in Cantonese, Mandarin, Spanish, Vietnamese, or Korean is preferred.