Medical Utilization Coordinator - Full Time

Pafford•Ridgeland, MS

5d•Onsite

About The Position

The Medical Utilization Coordinator is responsible for pre-billing processes, including chart review, insurance verification, and collection of necessary documentation. This role involves working with the Medical Utilization Officer on patient accounts, maintaining PCS forms, and ensuring all necessary documents for billing and prior authorization are collected. The coordinator will daily review medical necessity forms, attach them to patient records, and collaborate with field management to obtain patient assessments. Key responsibilities include professional communication with customers, interacting with payers for payment information and pre-authorization, verifying payor coverage, and staying updated on payor regulations. The position requires representing the organization professionally and working effectively in a team environment. Non-essential duties include performing other assigned tasks.

Requirements

Able to work independently.
High level computer skills.
Excellent interpersonal skills.
Service oriented.
High school diploma or GED
Current state driver’s license.
Maintains professional competence and demonstrates concern for the competence of other members of the EMS health care team.
Maintain HIPAA Compliance.
Strong ability to multi-task at a high pace environment.
Ability to uphold standards of practice and education.
Ability to adhere to standards of personal ethics, on and off duty, which reflect credit upon the profession.
Does not use professional knowledge and skills in any enterprise detrimental to the Company or to the public well-being.
Ability to respect and hold in confidence all information of a confidential nature obtained in the course of professional work unless required by law to divulge such information.
Has good working knowledge of all company policies pertaining to this position.
Good knowledge of common physical illnesses, obvious symptoms, and medical terminology.

Nice To Haves

One (1) year EMS dispatch experience.
Currently state certified EMT

Responsibilities

Pre-Billing inclusive of but not limited to Charts, Insurance Verification, and collection of needed documentation.
Work with Medical Utilization Officer on repetitive patient accounts.
Maintaining current PCS forms and documents needed for billing to obtain prior authorization.
Daily review of fax/scanned medical necessity forms, and attachment of those forms to patient records in CAD.
Work with field management staff to obtain patient assessments when needed.
Communicate with customers in a professional manner.
Interact with payers to secure timely payment information and/or pre-authorization.
Verify payor coverage through resources available.
Maintain knowledge of payor regulations including need for pre-authorizations.
Represent the organization professionally and appropriately.
Ability to work in and participate in a team environment.