The UM Coordinator is responsible for data entry of authorization requests for inpatient and outpatient services. Processes PCP to Specialist referrals and entries into health plan portal. Performs a variety of administrative, support and clerical functions. Resolves issues and inquiries in a timely manner.
- Performs accurate and timely data entry of authorization requests for Inpatient or outpatient services. Ensures that insurance information is correct, updating and correcting information as needed, and in a timely manner. Obtains medical records from facilities and distributes to UM Concurrent Review Nurse to aid in the level of care review. Triggers notification to PCP of patient admit and discharge.|- Handles stat calls for assigned team on a daily basis and adheres to department standards for coverage queues to ensure turn-around time is three days from date of receipt (per policy). Documents all pertinent/required information in Referral Management Platform. Cover ACD phone line in accordance with department policies and procedures.|- Assists UM Nurse with creation of denial letters. Maintains inpatient fax pod and queue line to accurately notify UM Nurse of daily admissions and transfer requests to sub-acute facilities. Scans information accurately and in a timely manner. Establishes and maintains effective filing systems, delivers and sends out mail in the most appropriate manner (standard mail, overnight mail, same day courier) to meet timeliness standards, and completes all other assigned clerical functions to ensure efficient operation of the department. Ensures the work area is clean, clutter free, and organized.|- Demonstrates appropriate use of independent judgement and decision making. Adheres to all department policies and procedures (attendance, dress code, etc.). Maintains confidentiality in accordance with organization/corporate policies and HIPAA privacy regulations.|- Backs up CM Coordinator as needed. Completes ad hoc projects/duties in a timely manner, as assigned. Demonstrates excellent customer service at all times.
- Strong knowledge of Medical Terminology
- One year of related office, business or administrative experience
- Must demonstrate excellent customer service skills and telephone etiquette
- Must be able to read, write and communicate effectively in English
- Computer literacy and proficiency - MS Office Suite
- Ability to type 60 words per minute
- Ability to establish and maintain effective working relationships at all levels of the organization
- Ability to communicate in a clear and concise manner
- Ability to maintain a work pace appropriate to the workload
- Ability to multitask and prioritize needs to meet timelinesHigh School Diploma or Equivalent