About the role
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