Remote Utilization Management Coordinator

integrapartners; United States; Hybrid; USD 22,000 - 31,000; Full time

Benefits offered by this job

Competitive compensation

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

Quarterly events

Wellness programs

Career development opportunities

Job summary

Integra Partners is seeking a UM Coordinator to support the clinical team with administrative tasks in processing utilization management authorizations and appeals. Responsibilities include processing UM requests, verifying documentation, and coordinating with providers.

You will learn Essette and Salesforce systems, improve time management, and work toward meeting deadlines. Remote opportunities exist across multiple states in the US.

Qualifications

• 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
• Experience with DMEPOS desired
• Medicare/Medicaid experience 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 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

Skills

Communication

Time management

Prioritization

Tools

Essette

Salesforce

Microsoft Word

Microsoft Outlook

Job description

Integra Partners is seeking a UM Coordinator to support the clinical team with administrative tasks in processing utilization management authorizations and appeals. Responsibilities include processing UM requests, verifying documentation, and coordinating with providers.

You will learn Essette and Salesforce systems, improve time management, and work toward meeting deadlines. Remote opportunities exist across multiple states in the US.