UM Coordinator
6 days ago
POSITION SUMMARY
Reports to Clinical Operations Manager. The Utilization Management Coordinator is responsible for processing and assisting with authorizations per day, reviewing authorizations for accuracy such as completeness which includes correct address, correct provider, all appropriate CPT codes, ICD-10 codes, and correct place of service/facility. Individuals must be able to execute effective communications verbally and in writing. Maintain patient confidentiality and promote departmental and organizational goals.
RESPONSIBILITIES-DUTIES
- Individuals will be available to assist Licensed Nursing staff with non-clinical tasks associated with the processing of prior authorizations but primarily assist other outpatient UM staff with daily tasks.
- If a member is not in the system, notifies eligibility by submitting member inquiry.
- Provides benefit and or guideline information to the authorization, Information is uploaded onto the authorization prior to passing to the clinical review UM Nurse, and/or Medical Director.
- Calls providers to obtain the supporting medical documentation needed for Prior Auth Nurse, and/or Medical Director to review.
- Educates providers as needed with the Authorization/Referral process under the direction on Admin Authorization Supervisor and Outpatient Prior Authorization Coordinator, II & III.
- Maintains confidentiality of all members and medical/clinical information.
- Performs as necessary to any departmental changes, workload and/or emergencies.
- Understands UM Policies/Procedures.
- Ensures the privacy and security of PHI(Protected Health Information)as outlined in AMM policies and procedures relating to HIPPA compliance.
- Performs other duties as directed by Admin Auth Supervisor and/or UM Director.
EDUCATION & EXPERIENCE REQUIREMENTS
- At least one year of related experience and/or training; or equivalent combination of education and experience preferred.
- Medical terminology training, medical or other healthcare related experience preferred. May be required to take additional training classes during first six months of employment.
- High school diploma or GED
- Must be able to communicate both orally and in writing.
- Ability to apply common sense, to read and comprehend simple to moderate instructions to carry out basic to detailed written and/or oral instructions.
- Must be able to efficiently prioritize multiple high priority tasks and or follow a set level of tasks assigned.
- Must have the ability to work as a team player, take instructions and follow through with tasks. Must also be able to follow simple instructions and be organized but requires moderate to minimal supervision.
- Must maintain strict confidentiality of all patient information and IPA business.
AMM BENEFITS
When you join AMM, you're not just getting a job—you're getting a benefits package that puts YOU first:
- Health Coverage You Can Count On: Full employer-paid HMO and the option for a flexible PPO plan.
- Wellness Made Affordable: Discounted vision and dental premiums to help keep you healthy from head to toe.
- Smart Spending: FSAs to manage healthcare and dependent care costs, plus a 401(k) to secure your future.
- Work-Life Balance: Generous PTO, 40 hours of sick pay, and 13 paid holidays to enjoy life outside of work.
- Career Development: Tuition reimbursement to support your education and growth.
- Team Fun: Paid company outings and lunches because we work hard, but we also know how to have fun
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