The Role
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 authorizations and appeals.
Rate of Pay: $19.00/hour
JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIES
The UM Coordinator’s responsibilities include but are not limited to:
EDUCATION: High school diploma required
EXPERIENCE:
WHAT WILL YOU LEARN IN THE FIRST 6 MONTHS?
WHAT WILL YOU ACHIEVE IN THE FIRST 12 MONTHS?
Rate of Pay: $19.00/hour
JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIES
The UM Coordinator’s responsibilities include but are not limited to:
- 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
- Make outbound calls to providers and members for verbal notification
- Make outreach including faxes and calls for more documentation
- 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 Leadership
- Ability to communicate with clients in a professional manner
- 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
EDUCATION: High school diploma required
EXPERIENCE:
- At least 1 year of experience as a UM Coordinator or similar administrative role within a health plan, managed care organization, or delegated UM entity.
- Familiarity with the UM process, including how authorization requests, appeals, and peer-to-peer reviews are routed and tracked within an authorization system.
- Comfortable working with clinical documentation (e.g. provider office notes, prescriptions, therapy assessments, sleep studies), with the ability to identify required components for submission.
- Experience working with ICD-10 and HCPCS codes, including verifying code accuracy, benefit limits, and documentation requirements.
- Able to use a fee schedule to confirm benefit coverage and determine allowable quantities or limits.
- Strong organizational and time management skills with the ability to prioritize and track multiple UM cases or requests simultaneously.
- Proficient computer skills required, including Microsoft Word, Outlook, and experience navigating healthcare software or authorization systems.
- Able to review documentation and cross-reference with policy or system requirements to confirm completeness, not for medical necessity.
- Strong written and verbal communication skills for professional interactions with providers and internal clinical staff.
- Experience with DMEPOS authorization workflows preferred.
- Familiarity with Medicare and/or Medicaid UM processes is preferred.
WHAT WILL YOU LEARN IN THE FIRST 6 MONTHS?
- How to work in authorization systems Essette and Salesforce
- Verbal notifications
- 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
Similar Jobs
Get Personalized Job Insights.
Our AI-powered fit analysis compares your resume with a job listing so you know if your skills & experience align.
Success! Refresh the page to see how your skills align with this role.
The Company
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
