- Full Time/Contract
- Member Services
- Rancho Cucamonga, CA
Our Client is a not-for-profit, rapidly growing Medi-Cal and Medicare health plan serving over 1,138,447 residents of the Riverside and San Bernardino counties. Our client maintains a Positive Team Culture as demonstrated by being voted by Los Angeles News Group readers as "Favorite Overall Company to Work For , "Favorite Training Program , and "Favorite Workplace Culture in their 2014 Winning Workplaces survey.
Under the general direction of the UM Manager and Supervisor, the UM Coordinator, is a high paced position that requires timely processing of authorization requests, verifying eligibility and obtaining additional information as requested by Medical Management or Utilization Management Nurses. This position requires that one be organized, ability to multi-task with a working knowledge of ICD.9/10, CPT Coding and Medical Terminology. The UM Coordinator will also ensure that provider calls are responded to in an accurate and timely manner while always maintaining highest level of customer service.
- Responsible for monitoring the Right Fax Server. Ensuring all referrals are processed in a timely manner and ensuring compliance with appropriate turnaround timeframes.
- Responsible for checking the referral form for completeness, obtaining missing demographic information as needed, and initial attempts at coding any uncoded referrals.
- Responsible for meeting accuracy standards for appropriate authorizations of referrals at the UM Coordinator level.
- Responsible for representing the health plan in a friendly and professional manner while answering the calls for the Utilization Management Department.
- Communicate with providers in consultation with the Utilization Management Nurse, regarding authorizations, modifications, denials and other matters pertinent to processing authorization requests or other UM related correspondence.
- Assist management or Utilization Management Nurses as requested.
- Any other duties as required ensuring Health Plan operations are successful.
- Ensure the privacy and security of PHI (Protected Health Information) as outlined in ‘s policies and procedures relating to HIPAA compliance.
QUALIFICATIONS / REQUIREMENTS
|Education/License:||High School diploma or equivalent required. Associates degree preferred. Medical Assistant Certificate preferred. Two (2) years of experience as a Medical Coordinator or Medical Office.|
|Experience:||Minimum of three years of experience as a data entry specialist or coordinator, preferably in an HMO or Managed Care setting.|
|Knowledge/Skills Required:||Knowledge of computer applications, including word processing, database and spreadsheets. Requires knowledge of ICD-9/10 and CPT codes. Managed Care or physician office a must. Good customer service skills.|
Full Time; Contract