UM COORDINATOR

JOB DUTIES

Reviews accounts as well as communicates with insurance companies to get appeal determinations.

Responds to telephone calls and messages from patients, insurance companies and staff courteously and promptly with an emphasis on effective resolution.

Reviews accounts to see if payment has been received and keep documentation log

Create and maintain department spreadsheets

Demonstrates knowledge of organizational policies regarding insurance appeals

Generates special reports as needed.

Assist Director of Utilization Management by creating meeting invites, PowerPoints, and work orders as needed. Will also assist Director with different case issues that come up throughout the day

Verify surgical pre-authorizations for elective surgery cases

Notify insurances of discharges

Assist with general cleanliness of department

Upload all faxes, letters and appeal letters to the account in care manager.

Demonstrates knowledge of various insurance programs regarding covered and non-covered services.

Notifies administrative personnel of important situations or problems.

Prepares monthly departmental reports

Ensures compliance in all regulatory areas.

Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.

Work with Denials staff and assist as needed

Order supplies for the office as needed

Answers office mainline phone and directs calls as needed

Takes care of sorting all faxes and communications received via mail etc and distributing to staff in timely manner

Responsible for assisting with MOON distributions to observation patients and certified mailings

Performs other duties as assigned.