Utilization Management Coordinator

Integra Partners•Troy, MI

8d•$19 - $19•Remote

About The Position

The UM Coordinator assists and supports the clinical team (UM Nurses/Medical Director) with administrative and non-clinical tasks related to processing Utilization Management prior authorizations and appeals. The role involves monitoring incoming faxes, entering UM authorization review requests into the UM platform using ICD-10 and HCPCS codes, verifying eligibility and claim history, and ensuring all necessary documentation is submitted. The coordinator will also contact providers for missing information, generate correspondence, complete verbal notifications, and document all actions in the authorization platform. Additionally, they will initiate appeal cases, ensure adherence to internal and regulatory deadlines, and handle inquiries from various sources. The position requires strong organizational skills, adaptability, and a desire to work in a fast-paced environment, with a team-oriented and self-motivated attitude.

Requirements

Knowledge of ICD-10, HCPCS codes and medical terminology required
Ability to prioritize multiple tasks using time management and organizational skills
Strong computer skills with proficiency in Word, Outlook and other software applications
Ability to collect data, establish facts and draw valid conclusions
Effective written and oral communication skills

Nice To Haves

1 year as a UM Coordinator in a managed care payer environment preferred
Experience with DMEPOS desired
Medicare/Medicaid experience a plus

Responsibilities

Monitor incoming faxes
Enter UM authorizations review requests in UM platform using ICD-10 and HCPCS codes
Verify eligibility and claim history in proprietary claims platform
Verify all necessary documentation has been submitted with authorization requests
Contact requesting providers to obtain medical records or other necessary documentation related to specific UM request
Generate correspondence and assist with faxing/mailing member and provider notifications
Complete verbal notifications
Document as required in authorization platform
Initiate appeal cases and forward to UM Nurses for completion
Meet internal and regulator deadlines for UM cases
Complete tasks assigned by UM Nurses and document as required
Complete inquiries received from call center and other internal & external sources
Other duties as assigned by UM Director