Healthcare Utilization & Provider Support Coordinator

Montage Health; Monterey (CA); On-site; USD 27,552 - 35,817; Full time

Job summary

Aspire HealthPlan is hiring a UM Health Services Coordinator to provide operational support for Utilization Management within a health plan. You will coordinate authorization intake, processing, and correspondence, while ensuring HIPAA and CMS compliance.

The role interacts with providers, members, and internal teams, handling escalations, data maintenance, and reports with strong organizational skills and attention to regulatory standards.

Qualifications

• Associate degree or equivalent combination of education and relevant experience.
• 3–5 years of experience in managed care, health insurance, utilization management, medical office operations, claims, or provider services.
• Working knowledge of medical terminology, insurance terminology, CPT/HCPCS/ICD coding, and authorization processes.
• Experience handling high-volume administrative workflows with accuracy and detail.
• Proficiency with Microsoft Office applications (Excel, Outlook, Word).
• Strong written and verbal communication skills.
• Ability to prioritize multiple assignments and meet deadlines.
• Ability to work independently and collaboratively in a fast-paced environment.

Responsibilities

• Coordinate intake, entry, and processing of utilization management requests from multiple submission channels.
• Perform preliminary review of authorization requests for completeness and eligibility.
• Route requests requiring clinical review to nurses or medical directors.
• Process expedited authorization requests and assist with documentation.
• Support denial and modification workflows, including notices.
• Manage information requests for incomplete submissions and follow up with providers.
• Assist with out-of-network provider searches and related tasks.
• Coordinate retroactive review and authorization-related claims resolution.

Skills

Medical terminology

MS Office

Written & verbal communication

Regulatory knowledge

Prioritization

Detail-oriented

Independent and collaborative work

Education

Associate degree or equivalent

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

Job description

Aspire HealthPlan is hiring a UM Health Services Coordinator to provide operational support for Utilization Management within a health plan. You will coordinate authorization intake, processing, and correspondence, while ensuring HIPAA and CMS compliance.

The role interacts with providers, members, and internal teams, handling escalations, data maintenance, and reports with strong organizational skills and attention to regulatory standards.