Utilization Management Coordinator

The UM Coordinator assists and supports the clinical team (UM Nurses/Medical Director) with administrative and non-clinical tasks related to processing Utilization Management prior authorization sand appeals. 

JOB RESPONSIBILITIES

• Monitor incoming faxes
• Enter UM authorizations review requests in UM platform using ICD-10 and HCPCS codes
• Verify eligibility and claim history in proprietary claims platform
• Verify all necessary documentation has been submitted with authorization requests
• Contact requesting providers to obtain medical records or other necessary documentation related to specific UM request
• Generate correspondence and assist with faxing/mailing member and provider notifications
• Complete verbal notifications
• Document as required in authorization platform
• Initiate appeal cases and forward to UM Nurses for completion
• Meet internal and regulator deadlines for UM cases
• Complete tasks assigned by UM Nurses and document as required
• Complete inquiries received from call center and other internal & external sources
• Other duties as assigned by UM Director
• Strong organizational skills, ability to adapt quickly to change and desire to work in a fast-paced environment
• Team oriented and self-motivated with a positive attitude

Pay: $19.00/hour

What will you learn in the first 6 months?

• Verbal notifications
• How to work in authorization systems Essette and Salesforce
• Incoming/outgoing faxing process
• Understanding the expectations and functions of the UM team
• Time Management

What will you achieve in the first 12 months?

• Expand knowledge of ICD-10 and HCPC codes
• Maintaining expected timelines

EXPERIENCE:

• 1 year as a UM Coordinator in a managed care payer environment preferred
• Knowledge of ICD-10, HCPCS codes and medical terminology required
• Ability to prioritize multiple tasks using time management and organizational skills
• Strong computer skills with proficiency in Word, Outlook and other software applications
• Ability to collect data, establish facts and draw valid conclusions
• Effective written and oral communication skills
• Experience with DMEPOS desired
• Medicare/Medicaid experience a plus