Remote UM Coordinator I: Utilization Care Advocate

PacificSource; Bend (OR); On-site; USD 36,000 - 57,000; Full time

Benefits offered by this job

Flexible telecommute policy

Medical, vision, and dental insurance

401(k) plan

Paid time off and holidays

Tuition reimbursement and training

Job summary

PacificSource is seeking a Utilization Management professional to support members and providers with prior authorizations, benefit details, and claims review in an office setting. The role emphasizes accuracy, HIPAA compliance, and collaboration with UM and care-management staff.

The position requires knowledge of CPT/HCPCS/ICD coding, strong communication, and a minimum of two years in health insurance or medical settings. Training and benefits are provided.

Qualifications

• Minimum of two years of health insurance industry or medical setting experience.
• One year experience with CPT/HCPCS/ICD coding preferred.
• High school diploma or equivalent required; associate degree or certifications preferred.

Responsibilities

• Coordinate, create, and document UM cases in the electronic record.
• Validate preauthorization requirements and document prior authorizations.
• Assist members and providers with benefit utilization and referrals.
• Provide excellent customer service via telephonic queue.
• Maintain HIPAA compliance and privacy throughout processes.

Skills

CPT/HCPCS/ICD coding

HIPAA compliance

Customer service

Education

High school diploma or equivalent

Associate degree

Medical assistant certification

Licensed professional nurse

Certified professional coder

Job description

PacificSource is seeking a Utilization Management professional to support members and providers with prior authorizations, benefit details, and claims review in an office setting. The role emphasizes accuracy, HIPAA compliance, and collaboration with UM and care-management staff.

The position requires knowledge of CPT/HCPCS/ICD coding, strong communication, and a minimum of two years in health insurance or medical settings. Training and benefits are provided.