Utilization Management Coordinator

Integra Partners•Troy, MI

2d•$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 authorization sand appeals. JOB 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 Strong organizational skills, ability to adapt quickly to change and desire to work in a fast-paced environment Team oriented and self-motivated with a positive attitude Pay: $19.00/hour What will you learn in the first 6 months? Verbal notifications How to work in authorization systems Essette and Salesforce Incoming/outgoing faxing process Understanding the expectations and functions of the UM team Time Management What will you achieve in the first 12 months? Expand knowledge of ICD-10 and HCPC codes Maintaining expected timelines

Requirements

1 year as a UM Coordinator in a managed care payer environment preferred
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
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