Um Coordinator

Meadville Medical Center • Meadville, PA

10d

About The Position

The Um Coordinator is responsible for reviewing accounts, communicating with insurance companies for appeal determinations, and responding to inquiries from patients, insurance companies, and staff. This role involves maintaining documentation, generating reports, and assisting the Director of Utilization Management with various tasks and case issues. The coordinator will also handle pre-authorizations for elective surgeries, notify insurances of discharges, and ensure departmental compliance and confidentiality.

Requirements

• Demonstrates knowledge of organizational policies regarding insurance appeals.
• Demonstrates knowledge of various insurance programs regarding covered and non-covered services.
• Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.

Nice To Haves

• Assists Director of Utilization Management by creating meeting invites, PowerPoints, and work orders as needed.
• Assists Director with different case issues that come up throughout the day.
• Verifies surgical pre-authorizations for elective surgery cases.
• Notifies insurances of discharges.
• Assists with general cleanliness of department.
• Works with Denials staff and assists as needed.
• Orders supplies for the office as needed.
• Answers office mainline phone and directs calls as needed.
• Takes care of sorting all faxes and communications received via mail etc and distributing to staff in timely manner.
• Responsible for assisting with MOON distributions to observation patients and certified mailings.

Responsibilities

• Reviews accounts and communicates with insurance companies to get appeal determinations.
• Responds to telephone calls and messages from patients, insurance companies, and staff courteously and promptly with an emphasis on effective resolution.
• Reviews accounts to see if payment has been received and keeps documentation log.
• Creates and maintains department spreadsheets.
• Demonstrates knowledge of organizational policies regarding insurance appeals.
• Generates special reports as needed.
• Assists Director of Utilization Management by creating meeting invites, PowerPoints, and work orders as needed.
• Assists Director with different case issues that come up throughout the day.
• Verifies surgical pre-authorizations for elective surgery cases.
• Notifies insurances of discharges.
• Assists with general cleanliness of department.
• Uploads all faxes, letters, and appeal letters to the account in care manager.
• Demonstrates knowledge of various insurance programs regarding covered and non-covered services.
• Notifies administrative personnel of important situations or problems.
• Prepares monthly departmental reports.
• Ensures compliance in all regulatory areas.
• Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.
• Works with Denials staff and assists as needed.
• Orders supplies for the office as needed.
• Answers office mainline phone and directs calls as needed.
• Takes care of sorting all faxes and communications received via mail etc and distributing to staff in timely manner.
• Responsible for assisting with MOON distributions to observation patients and certified mailings.
• Performs other duties as assigned.

What This Job Offers

• Career Level: Mid Level
• Education Level: No Education Listed