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Utilization Management Outpatient Coordinator

3 months ago

Rancho Cucamonga, United States Alura Workforce Solutions Full time
Position

Coordinator- Utilization Management Outpatient

Description

Under the general direction of the UM Outpatient Manager and Supervisor, the Outpatient UM Coordinator, is a high paced position that requires timely processing of authorization requests, verifying eligibility and obtaining additional information as requested by Medical Management or Utilization Management Nurses. This position requires that one be organized, ability to multitask with a working knowledge of ICD.9/10, CPT Coding and Medical Terminology. The Outpatient UM Coordinator will also ensure that provider calls are responded to in an accurate and timely manner while always maintaining the highest level of customer service.
  1. Responsible for monitoring the Right Fax Server. Ensuring all referrals are processed in a timely manner and ensuring compliance with appropriate turnaround timeframes.
  2. Responsible for checking the referral form for completeness, obtaining missing demographic information as needed, and initial attempts at coding any uncoded referrals.
  3. Responsible for meeting accuracy standards for appropriate authorizations of referrals at the UM Coordinator level.
  4. Responsible for representing the Inland Empire Health Plan in a friendly and professional manner while answering the calls for the Utilization Management Department.
  5. Communicate with providers in consultation with the Utilization Management Nurse, regarding authorizations, modifications, denials, and other matters pertinent to processing authorization requests or other UM related correspondence.
  6. Assist Management or Utilization Management Nurses as requested.
Requirements
  • Minimum of three (3) years of experience as a data entry specialist or coordinator.
  • Experience as a data entry specialist or coordinator preferably in an HMO or Managed Care setting.
  • High school diploma or GED required.
  • Associate's degree or Bachelor's degree from an accredited institution preferred.
  • Medical Assistant certificate preferred.
  • Requires knowledge of ICD-9/10 and CPT codes. Managed Care or physician office a must.
  • Skilled in computer applications, including word processing, database, and spreadsheets. Good customer service skills.

INDH