Utilization Management Coordinator

Altais•Remote - CA, CA

7d•$25 - $30

About The Position

Altais is a growing, dynamic team focused on transforming healthcare. As a Utilization Management (UM) Coordinator, you will collaborate with various internal teams, including Ambulatory and Concurrent Care, Network Management, Quality Improvement, and Practice Success. Your primary role is to ensure efficient authorization processes and expertly navigate insurance requirements. We are looking for individuals dedicated to patient-centered care and 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

Manage all incoming authorizations received via Tapestry Link portal or OnBase, including eligibility and benefit verification, and data entry into Tapestry, adhering to established Turn Around Times (TAT) and Industry Collaboration Effort (ICE) regulations.
Serve as the main point of contact for internal and external customers seeking information or assistance regarding authorizations.
Review authorization requests according to established levels of review.
Prepare denial letters under the supervision of professional staff and provide accurate technical information to provider offices and internal customers.
Contact provider offices by telephone to obtain missing clinical documentation required for medical review and document requested information in Tapestry.
Cross-train with all UM Coordinators to ensure complete process knowledge and coverage availability.
Maintain strict confidentiality of all health records and member information, ensuring compliance with HIPAA guidelines.