Utilization Management Coordinator - Casual

Altais•Remote - CA, CA

3d•$25 - $30

About The Position

Altais is seeking a Utilization Management (UM) Coordinator to join their fast-growing, dynamic team. This role is a 6-month contract opportunity where you will work closely with the Ambulatory and Concurrent Care, Network Management, Quality Improvement, and Practice Success teams. Your responsibilities will include driving efficient authorization processes and navigating insurance requirements with precision and advocacy. The ideal candidate will have a strong commitment to patient-centered care and a passion for promoting health and wellness.

Requirements

High school diploma
Two years previous UM experience, medical records, medical billing, or medical office experience.
2-3 years Microsoft Office programs experience required.
Certificate or equivalent experience in medical terminology, CPT, HCPCS, and ICD coding required.

Responsibilities

Responsible for all incoming authorizations, whether received via Tapestry Link portal or OnBase.
Authorizations may require eligibility or benefit verification and data entry into Tapestry before processing and are governed by established Turn Around Times (TAT) consistent with the Industry Collaboration Effort (ICE) regulations.
Function as the primary contact for internal and external customers requesting information or assistance related to authorizations.
Review authorization requests per established level of review designation.
Prepare denial letters under the supervision of the professional staff.
Works closely with professional staff and customer service to provide accurate technical information to provider offices and internal customers in a professional manner.
Contact provider offices by telephone for missing clinical documentation necessary for medical review and document information requested in Tapestry.
Cross train with all UM Coordinators to learn each process completely to ensure coverage is available.
Ensure strict confidentiality of all health records, member information and meet HIPAA guidelines.