What are the responsibilities and job description for the CDI Specialist position at IMAS?
CDI Specialist
On Site in Pasadena, CA
SUMMARY:
This person will process authorizations and ensure that all information is correct before submitting for approval. All authorizations should be entered within a timely manner with complete data as well as the all the documents that will support medical necessity. The UM Coordinator will need to provide strong written/communication skills with Medical Director, Providers, and members to ensure the delivery of high-quality effective healthcare.
Duties & Responsibilities include but not limited:
- Open and process UM incoming faxes periodically throughout the business day
- Applies working knowledge of ICD-10 CM & PCS, MS-DRG reimbursement methodology, and Standard of Care in daily medical records reviews.
- Answer phones: Providing customer service to calls from providers and /or members
- Print approvals and modification letters from the database on a daily basis
- Scan any faxes to existing authorizations in the system
- Route medical reviewer's cases to appropriate personnel in timely manner on a daily basis
- Verify duplicate requests and call/notify doctor's office of referral request cancellations
- Contact and follow up with providers on pending clinical/documents within the turnaround time. (Routine 5 days, Urgent 72 hours)
- Verify and update all missing information (DOS, POS, outpatient or inpatient) before submitting for approval
- Must have experience in making outgoing phone calls as well as taking incoming phone inquiries **Perform additional UM functions as required by the department
SKILLS/Abilities
- Demonstrate proficiency in 10 key and computer use.
- Excellent communication
- Detail oriented
- Self-motivated
- Work effectively in a fast pace work environment
- Strong organizational and task prioritization
- Establish the ability to multitask and adjust to the workload
- Strong work ethic
- Provide positive attitude
Education:
High School Diploma
1 year of experience a MUST
Imperial Management Administrators Services (IMAS) is an Equal Opportunity Employer (EOE) and strongly supports diversity in the workplace. All qualified applicants will receive consideration for employment without regard to race, sex, color, religion, sexual orientation, gender identity, gender expression, national origin, protected veteran status, or on the basis of disability.
Job Type: Full-time
Pay: $24.66 - $30.00 per hour
Work Location: In person
Salary : $25 - $30