Job Description - UM Coordinator

Reports to the Clinical Operations Manager. The Utilization Management Coordinator is responsible for processing and assisting with 80-100 authorizations per day, reviewing authorizations for accuracy such as completeness which includes correct address, correct provider, all appropriate CPT codes, ICD-10 codes, and correct place of service/facility. Individual must be able to execute effective communications verbally and in writing. Maintain patient confidentiality, and promote departmental and organizational goals.

RESPONSIBILITIES-DUTIES

· Individual will be available to assist Licensed Nursing staff with non-clinical tasks associated with the processing of prior authorizations but primarily assist other outpatient UM staff with daily tasks.

· If member is not in the system, notifies eligibility by submitting member inquiry thru Cerecon’s.

· Provides benefit and or guideline information to the authorization, Information is uploaded onto the authorization prior to passing to the clinical review UM Nurse, and/or Medical Director.

· Calls providers to obtain the supporting medical documentation needed for Prior AUTH Nurse, and/or Medical Director to review.

· Educates providers as needed with the Authorization/Referral process under the direction on Admin Authorization Supervisor and Outpatient Prior Authorization Coordinator, II & III.

· Maintains confidentiality of all members and medical/clinical information.

· Performs as necessary to any departmental changes, workload and/or emergencies.

· Has understanding of UM Policies/Procedures.

· Ensures the privacy and security of PHI(Protected Health Information)as outlined in AMM policies and procedures relating to HIPPA compliance.

· Works Cerecon’s Dashboard making requested modifications as needed from providers.

· Performs other duties as directed by Admin AUTH Supervisor and/or UM Director.

EDUCATION & EXPERIENCE REQUIREMENTS

· At least one year of related experience and/or training; or equivalent combination of education and experience preferred

· Medical terminology training, medical or other healthcare related experience preferred. May be required to take additional training classes during first six months of employment.

· High school diploma or GED

· Must be able to communicate both orally and in writing.

· Ability to apply common sense, to read and comprehend simple to moderate instructions to carry out basic to detailed written and/or oral instructions.

· Must be able to efficiently prioritize multiple high priority tasks and or follow a set level of tasks assigned.

· Must have the ability to work as a team player, take instructions and follow through with tasks. Must also be able to follow simple instructions and be organized but requires moderate to minimal supervision.

Must maintain strict confidentiality of all patient information and IPA business

AAP/EEO Statement

It is the policy of Advanced Medical Management to provide equal opportunity for all applicants and employees. The Company does not unlawfully discriminate on the basis of race, creed, color, religion, sex sexual orientation, gender, gender identity, national origin, ancestry, age, medical condition or genetic characteristic, physical or mental disability, family care or medical leave status, military status, pregnancy, marital or domestic partner status, veteran status, or any other status protected by state or federal law.

Job Type: Full-time

Pay: $18.00 - $23.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Employee discount
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Experience:

• Medical terminology: 1 year (Preferred)
• Computer skills: 1 year (Preferred)

Ability to Relocate:

• Long Beach, CA 90815: Relocate before starting work (Required)

Work Location: In person