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
EXPERIENCE:
- 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
Skills Required
- Knowledge of ICD-10 codes
- Knowledge of HCPCS codes
- Knowledge of medical terminology
- 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
- One year of experience as a Utilization Management Coordinator in a managed care payer environment
- Experience with DMEPOS
- Medicare or Medicaid experience
What We Do
Integra Partners is a leading network management company that connects Orthotics and Prosthetics (O&P) and Durable Medical Equipment (DME) providers with health plans and their patients. The company works with more than 50 health plans and has over 4,000 provider locations in its network. For more information on Integra Partners, visit www.accessintegra.com
