Remote Utilization Management Coordinator

Integra Partners; Northern (KY); Hybrid; USD 26,000 - 29,000; Full time

Benefits offered by this job

401(k) retirement program with company

Company-paid life insurance

Short term disability coverage

Medical, Vision, and Dental benefits

Paid Time Off

Parental Leave

Sick Time

Paid holidays & floating holidays

Career development opportunities

Job summary

Integra Partners seeks a UM Coordinator to support the clinical UM team with administrative tasks related to processing prior authorizations and appeals. The role requires monitoring faxes, entering requests in the UM platform using ICD-10/HCPCS, and verifying eligibility and documentation for approvals.

You will contact providers for records, generate correspondence, and initiate appeal cases while meeting internal and regulator deadlines.

Qualifications

• 1 year UM Coordinator experience in a managed care environment preferred.
• Knowledge of ICD-10, HCPCS codes and medical terminology required.
• Ability to prioritize multiple tasks with strong time management.
• Strong computer skills with Word, Outlook and other software applications.
• Experience with DMEPOS and Medicare/Medicaid is a plus.

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.
• Generate correspondence and assist with faxing/mailing 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 from call center and other sources.

Skills

Time management

Organizational skills

Communication skills

Prioritization

Teamwork

Tools

Essette

Salesforce

Microsoft Word

Outlook

Job description

Integra Partners seeks a UM Coordinator to support the clinical UM team with administrative tasks related to processing prior authorizations and appeals. The role requires monitoring faxes, entering requests in the UM platform using ICD-10/HCPCS, and verifying eligibility and documentation for approvals.

You will contact providers for records, generate correspondence, and initiate appeal cases while meeting internal and regulator deadlines.