UM Coordinator

Brighton Health Plan Solutions, LLC • Chapel Hill, NC

23d

About The Position

The UM Coordinator is responsible for coordinating all aspects of the prior authorization process, including member eligibility and benefit verification, gathering necessary clinical information from electronic medical record, and timely communication with members, providers and facility staff. Candidates should possess knowledge of third-party reimbursement regulations and medical terminology. Success in this role will require strong interpersonal communication, critical thinking, and problem-solving skills. The successful candidate will interact and communicate effectively with internal and external customers, providers in clinical settings, and all members of the organization.

Requirements

• HS diploma or GED is required.
• Strong skills in medical record review.
• Excellent customer service and communication skills.
• Ability to define problems, obtain data, and establish facts.
• Ability to work proficiently on a computer (PC) with working knowledge of Microsoft Word and Excel.
• Excellent data entry skills.
• Familiarity with medical terminology required.
• Familiarity with third party payor processes and procedures strongly desired.

Nice To Haves

• Bachelor’s degree preferred, but not required.

Responsibilities

• Research and confirm authorization requirements and communicate to member, providers, and facility staff.
• Collect data upon notification from patient/patient representative, physician, or hospital; verify member eligibility, plan participation and provider participation status.
• Create cases within documentation system in accordance with departmental workflows, policies, and procedures.
• Identify and correctly attach clinical documentation to appropriate cases within the documentation system.
• Interact telephonically with members, providers, and facilities to determine requests for type of care.
• Maintain accurate documentation within the clinical record according to workflows, policies and procedures.
• Collaborate with the clinical team to address provider or member questions, issues, or concerns.
• Play an active role in continuous improvement activities and quality initiatives to support positive outcomes for members, providers, and clients.
• Maintain professional communication with all internal and external stakeholders.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 11-50 employees