UM COORDINATOR

Meadville Medical Center • Meadville, PA

11d

About The Position

This role involves coordinating utilization management processes, including handling insurance appeals, patient communication, documentation, and reporting. The UM Coordinator will work closely with the Director of Utilization Management and other staff to ensure efficient operations and compliance with regulations.

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

• Experience with creating meeting invites, PowerPoints, and work orders.
• Experience with MOON distributions and certified mailings.

Responsibilities

• Reviews accounts and communicates with insurance companies to obtain appeal determinations.
• Responds to telephone calls and messages from patients, insurance companies, and staff courteously and promptly, focusing on effective resolution.
• Reviews accounts to verify payment receipt and maintains a documentation log.
• Creates and maintains department spreadsheets.
• Demonstrates knowledge of organizational policies regarding insurance appeals.
• Generates special reports as needed.
• Assists the Director of Utilization Management with creating meeting invites, PowerPoints, and work orders.
• Assists the Director with various case issues that arise.
• Verifies surgical pre-authorizations for elective surgery cases.
• Notifies insurance companies of patient discharges.
• Assists with the general cleanliness of the 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 strict confidentiality and adheres to all HIPAA guidelines/regulations.
• Works with Denials staff and provides assistance as needed.
• Orders supplies for the office as needed.
• Answers the office mainline phone and directs calls as needed.
• Sorts all faxes and communications received via mail, distributing them to staff in a timely manner.
• Assists with MOON distributions to observation patients and certified mailings.
• Performs other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed