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Outpatient Utilization Management Coordinator

2 months ago

Rancho Cucamonga, California, United States Alura Workforce Solutions Full time
Position

Outpatient Utilization Management Coordinator

Overview

Under the supervision of the Utilization Management Outpatient Manager and Supervisor, the Outpatient Utilization Management Coordinator plays a critical role in the efficient processing of authorization requests. This dynamic position necessitates prompt verification of eligibility and the gathering of supplementary information as required by Medical Management or Utilization Management Nurses. The ideal candidate will exhibit strong organizational skills, the ability to handle multiple tasks simultaneously, and possess a solid understanding of ICD-9/10, CPT Coding, and Medical Terminology. The Outpatient Utilization Management Coordinator is also responsible for ensuring that provider inquiries are addressed accurately and promptly while consistently delivering exceptional customer service.
  1. Oversee the Right Fax Server to ensure all referrals are processed efficiently and in compliance with established turnaround timeframes.
  2. Verify the completeness of referral forms, obtain any missing demographic information, and make initial attempts at coding any uncoded referrals.
  3. Meet accuracy standards for appropriate authorizations of referrals at the Coordinator level.
  4. Represent the organization in a professional and courteous manner while handling calls for the Utilization Management Department.
  5. Engage with providers in collaboration with the Utilization Management Nurse regarding authorizations, modifications, denials, and other relevant matters related to processing authorization requests or other UM correspondence.
  6. Support Management or Utilization Management Nurses as needed.
Qualifications
  • A minimum of three (3) years of experience in a data entry or coordination role.
  • Prior experience in a data entry or coordination capacity within an HMO or Managed Care environment is preferred.
  • A high school diploma or GED is required.
  • An Associate's or Bachelor's degree from an accredited institution is preferred.
  • A Medical Assistant certificate is advantageous.
  • Proficient knowledge of ICD-9/10 and CPT codes is essential, with experience in Managed Care or a physician office being a must.
  • Competency in computer applications, including word processing, databases, and spreadsheets, along with strong customer service skills.