Hello, I’m a healthcare administrative operations specialist with 3+ years of experience, currently supporting Medi-Cal Enhanced Care Management (ECM) and Community Supports (CS) programs in California. I’m looking to move into a healthcare operations, authorization, managed care, provider operations, referral, or similar role where my experience can be put to better use. My current work goes considerably beyond general administrative support. I manage healthcare authorization and eligibility workflows across multiple Managed Care Plans, maintain and reconcile client information across EHR and payer systems, coordinate referrals, resolve payer/provider issues, produce operational reports, and support compliance requirements. Some of my current responsibilities include: Submitting and tracking ECM, Housing Navigation, Housing Tenancy, and Housing Deposits authorization requests for Health Net, Anthem Blue Cross, Central California Alliance for Health, and Partnership HealthPlan of California Verifying eligibility, enrollment, demographics, and care-management assignments across payer systems and Credible EHR Monitoring authorization approvals, denials, requests for clarification, and outstanding issues through payer portals and fax systems Reconciling discrepancies between EHR records, Managed Care Plan data, enrollment information, provider assignments, and service documentation Producing weekly and month-end operational reports covering client demographics, program enrollment, payer, county, populations of focus, and outreach status Managing external referral intake through email distribution groups, FindHelp, and partner organizations Coordinating with care managers, Managed Care Plans, community organizations, and CDCR on referrals and warm handoffs Completing recurring OIG, EPLS, MSIL, and BreEZe compliance screenings Systems/tools include Credible EHR, Availity, FindHelp, Concord Fax, Managed Care Plan portals, SFTP systems, Microsoft 365, Excel, and Google Workspace. I’m based in Fresno, California and am particularly interested in remote opportunities, although I’m also open to appropriate Fresno-based positions. Target compensation: $25+/hour, depending on responsibilities and benefits. If my background fits something your organization is hiring for, please send me a Reddit DM with information about the position, employer, compensation range, and work arrangement. I’m happy to provide my full résumé and contact information privately.   submitted by   /u/Trentrick_Lamar [link]   [comments]