UM Coordinator, Pre-Service (Remote | Pacific Time Schedule)

Alignment Health

2d•$41,472 - $62,208•Remote

About The Position

Alignment Health is seeking an organized, detail-oriented and customer service oriented utilization management (UM) Coordinator to join the utilization management pre-service team. As a UM coordinator, you get to assist and support the clinical team, UM nurse, and medical director with administrative task related to processing UM's clinical referrals. If you are hungry to learn and grow, want to be part of a growing organization, and make a positive impact in the lives of seniors – we’re looking for you!

Requirements

Minimum (1) year experience in a medical setting working with IPAs, entering referrals / prior authorizations preferred.
Knowledge of ICD10, CPT codes, Medicare Managed Care Plans, medical terminology (certificate preferred) and referral system (Access Express/Portal/N-coder).
High school diploma or general education degree (GED) and / or training: or equivalent combination of education and experience required.
Computer proficient
Able to type minimum 50 words per minute (WPM)
Experience with Microsoft Office (Word, Excel, Outlook)
Experience with the application of UM criteria (i.e., CMS National and Local Coverage Determinations, etc.)
Proficient in Microsoft Office (Outlook, Excel, Word)
Able to type minimum 35 words-per-minute (WPM).
Organized and detail oriented.
File systematically.
Good interpersonal skills.
Strong written, verbal, and telephonic communication skills
Able to read, write, and speak English fluently.
None

Nice To Haves

Bilingual English / Spanish preferred
Medical assistant experience preferred
Knowledge working in Access Express / Portal, Epic preferred.
Medical Terminology Certificate preferred.

Responsibilities

Monitor fax folders.
Verify eligibility and / or benefit coverage for requested services.
Enter pre-service requests/authorizations in system using ICD 10 and CPT coding.
Verify all necessary documentation has been submitted for pre-service request.
Contact and request medical records, orders, and/or necessary documentation from requesting provider in order to process related pre-service requests/authorizations when necessary.
Document the referral process and any pertinent determination factors within the referral system.
Process pre-service request for medical services such as DME, office visits and radiology using approval criteria.
Assist with mailing or faxing correspondence to PCP’s, Specialists, related to requests / authorizations as needed.
Contact members and maintain documentation of call for Expedited requests.
Complete tasks assigned by nurse and document accordingly.
Answer queue calls relating to UM review and pre-service status.
Recognize work-related problems and contributes to solutions.
Meet specific deadlines and respond to various workloads by assigning task priorities according to department policies, standards and needs.
Maintain confidentiality of information between and among health care professionals.
Be a positive team player.