Member and Provider Notification Coordinator
7 days ago
Summary
The Outpatient UM Member and Provider Notification Coordinator will report directly to Lead/Supervisor. Their primary role is to provide timely notifications to members/providers of a referral authorization and assist the member with specialist appointments.
Duties and Responsibilities
· Maintain knowledge of standard regulations for decision and notification turnaround timeframes for all lines of business (Medi-Cal, Commercial, & Medicare)
· Provide member notification
o Make outbound calls to notify members of a referral/authorization
o Receiving and responding to member inbound phone calls
o Research member’s history for current phone numbers
o Validate current phone and fax numbers for both members and providers
o Actively listen to members and identify their needs
o Assist with scheduling appointments
o Communicate unable to contact (UTC) members to Case Management team with complex care diagnosis i.e. major organ transplant candidate, high risk diagnosis
· Provide Primary Care Physician (PCP) and/or Specialist Care Provider (SPC) notification
o Outreach PCP or SPC for additional medical records for referral/authorization
o Review failed fax report daily
o Outreach SPC when a failed fax has been identified to rectify the providers fax number and re-fax notification
· Document member and provider outreach in EZCAP
· Escalate issues to direct lead as appropriate
· Read and maintain email inquiries
· Collaborate with other departments (i.e. Claims, PNO, etc.) to resolve member/provider matters as needed
· Assist with special projects, as needed
· Assists other team members with their workload, as needed
· Regular attendance at UM team meetings
Minimum Job Requirements
· High School graduate or GED equivalent
· One-year medical office experience
· Bilingual
· Knowledge of medical terminology
· Proficiency in Microsoft Office programs, especially Word and Excel
· Proficiency in EZCAP a plus
Skill and Abilities
- Strong customer service skills with good telephone rapport
· Ability to multi-task while remaining adaptable and flexible to fast-paced environment
- Reliable, dependable, and accountable
· Ability to empathize with complex cases
- Self-Motivation and ability to work effectively in an independent environment
- Great critical thinking and problem-solving skills
-
Inpatient UM Coordinator
14 hours ago
Los Angeles, United States MedPOINT Management Full timeJob DescriptionJob DescriptionThis position works collaboratively with other members of the Clinical Care Coordination team to ensure that authorization requests, provider and member inquiries are handled appropriately, within established timeframes and utilizing established guidelines. Duties and Responsibilities · Process incoming and outgoing faxes.·...
-
Membership Coordinator
7 days ago
Los Angeles, United States Preferred IPA of California Full timeJob DescriptionJob DescriptionGENERAL SUMMARYThe Membership Dept. is responsible for researching, adding, terming and updating member information in the Membership System and researching member eligibility in Health Plan and government agency websites to maintain accurate information in the Membership System.PRINCIPAL DUTIES AND RESPONSIBILITIES: Research...
-
Provider Dispute Resolution Intake Coordinator II
Found in: beBee S US - 6 days ago
Los Angeles, United States L.A. Care Health Plan Full timeSalary Range: $45,760.00 (Min.) - $47,823.00 (Mid.) - $55,818.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million...
-
Provider Dispute Resolution Intake Coordinator II
Found in: beBee jobs US - 6 days ago
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $45, Min.) - $47, Mid.) - $55, Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...
-
Enhanced Care Management Coordinator II
Found in: beBee jobs US - 2 weeks ago
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $50, Min.) - $62, Mid.) - $75, Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...
-
Marketing and Project Coordinator
7 days ago
Los Angeles, United States Faith and Community Empowerment Full timeJob DescriptionJob DescriptionWe are seeking a dynamic individual to fulfill the role of Program & Social Media Coordinator. This position offers a unique opportunity to blend program coordination responsibilities with social media management under the supervision of the CEO. The successful candidate will be responsible for coordinating various programs such...
-
Marketing and Project Coordinator
1 hour ago
Los Angeles, United States Faith and Community Empowerment Full timeJob DescriptionJob DescriptionWe are seeking a dynamic individual to fulfill the role of Program & Social Media Coordinator. This position offers a unique opportunity to blend program coordination responsibilities with social media management under the supervision of the CEO. The successful candidate will be responsible for coordinating various programs such...
-
Marketing and Project Coordinator
7 days ago
Los Angeles, United States Faith and Community Empowerment Full timeJob DescriptionJob DescriptionBenefits:Health insurance We are seeking a dynamic individual to fulfill the role of Program & Social Media Coordinator. This position offers a unique opportunity to blend program coordination responsibilities with social media management under the supervision of the CEO. The successful candidate will be responsible for...
-
Marketing and Project Coordinator
2 weeks ago
Los Angeles, United States Faith and Community Empowerment Full timeJob DescriptionJob DescriptionBenefits:Health insurance We are seeking a dynamic individual to fulfill the role of Program & Social Media Coordinator. This position offers a unique opportunity to blend program coordination responsibilities with social media management under the supervision of the CEO. The successful candidate will be responsible for...
-
Marketing and Project Coordinator
1 hour ago
Los Angeles, United States Faith and Community Empowerment Full timeJob DescriptionJob DescriptionBenefits:Health insurance We are seeking a dynamic individual to fulfill the role of Program & Social Media Coordinator. This position offers a unique opportunity to blend program coordination responsibilities with social media management under the supervision of the CEO. The successful candidate will be responsible for...
-
Enhanced Care Management Coordinator II
Found in: beBee S US - 2 weeks ago
Los Angeles, United States L.A. Care Health Plan Full timeSalary Range: $50,216.00 (Min.) - $62,770.00 (Mid.) - $75,324.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million...
-
MDS Coordinator/Registered Nurse
Found in: beBee jobs US - 7 days ago
Los Angeles, California, United States Northridge Care Center Full timeNorthridge Care Center is looking for a Part-time MDS Coordinator to join our team The MDS Coordinator completes MDS for all residents according to OBRA and PPS guidelines. Assists in providing a clean, safe, happy and healthy environment for residents by performing the duties as described below. The goal is to promote the patient's well-being by providing...
-
UM Member Liaison
6 days ago
Los Angeles, United States MedPOINT Management Full timeJob DescriptionJob DescriptionSummaryThe UM Member Liaison acts as an advocate on behalf of the member to address any concerns or questions they may have regarding their medical care relationship(s) with providers. The Liaison also works closely with the health plans with member assignment and access to care. The UM Member Liaison reports directly to the...
-
Principal Proposal Coordinator
7 days ago
Los Angeles, United States Hazen and Sawyer Full timeJob DescriptionJob Description Join our Hazen team and make the world a better place, providing exceptional client service in all things water® and superior technical solutions for our clients. Hazen is a creative, employee-owned company with minimal bureaucracy where employees thrive. Hazen has outstanding opportunities for motivated, talented people who...
-
Credentialing Coordinator
7 days ago
Los Angeles, United States Keck Medical Center of USC Full timeThe Credentialing Coordinator is responsible for assuring that the credentialing of practitioners is conducted in accordance with the Office of Integrated Credentialing/client policies and procedures, entity bylaws/credentialing plan, regulatory agencies, and accrediting bodies. The Credentialing Coordinator performs quality control audits and coordinates...
-
Member Records Processor
7 days ago
Los Angeles, United States Ironworker Employees' Benefit Corporation Full timeJob DescriptionJob DescriptionJob purposeThe Member Records Processor is responsible for inputting all new members and dependents into the various vendor files for eligibility based on their hours worked. We answer the members phone calls and provide excellent customer service in the office.Duties and ResponsibilitiesProcess all Enrollment forms for the...
-
Los Angeles, United States TELACU Residential Management Inc. Full timeTELACU Residential Management, Inc. (TRM) has developed thousands of apartment homes, creating beautiful residential communities throughout California. These communities are operated by TELACU Residential Management, Inc. (TRM), which provides the highest levels of in-house oversight, security, maintenance and social service care that our residents deserve....
-
Care Coordinator
7 days ago
Los Angeles, United States Center for Family Health and Education Full timeJob DescriptionJob DescriptionWe are seeking a Care Coordinator to become a part of our team! You will coordinate medical and health services in hospitals, clinics or similar organizations.Responsibilities:Oversee medical and health service activities and personnel Plan and coordinate health servicesWork collaboratively with physicians to...
-
Customer Solution Center Member Advocate II
Found in: beBee jobs US - 2 weeks ago
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $67, Min.) - $87, Mid.) - $107, Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...
-
Care Coordinator
7 days ago
Los Angeles, United States Lakeside Medical Full timeThe Care Coordinator is responsible for navigating the care management across the continuum of care of the member from acute to outpatient case management. The Coordinator, Care role is to incorporate administrative job functions to provide optimal care and coordination of care. The individual will assist with both the Inpatient (Acute/Skilled) and case...