UM Authorization Specialist — EZCAP & Compliance

Advanced Medical Management, Inc.; Long Beach (CA); On-site; USD 40,000 - 60,000; Full time

Benefits offered by this job

Full employer-paid HMO

Discounted vision and dental premiums

401(k) plan

Generous PTO

Tuition reimbursement

Paid company outings and lunches

Job summary

Advanced Medical Management, Inc. in Long Beach, California, is seeking a Utilization Management Coordinator to coordinate prior authorization requests and support utilization review activities. The candidate will work closely with health plans, providers, and internal departments to ensure compliance with CMS and DHCS regulations.

Required qualifications include a High School Diploma and at least one year of healthcare experience. The position offers a range of benefits including health coverage, paid time off, and professional development opportunities.

Qualifications

• Knowledge of medical terminology, ICD-10 diagnosis coding, and CPT/HCPCS procedure coding.
• Experience in healthcare with managed care experience preferred.
• Familiarity with HIPAA regulations and CMS regulations.

Responsibilities

• Coordinate prior authorization requests and processing referrals.
• Document case activity and support timely utilization review activities.
• Ensure compliance with CMS, DHCS, and NCQA requirements.

Skills

Strong organizational skills

Time management

Critical thinking

Multitasking

Problem solving

Ability to prioritize urgent work

Education

High School Diploma or GED

Tools

EZCAP Authorization System

Microsoft Outlook

Microsoft Word

Microsoft Excel

Adobe Acrobat

Electronic Fax Systems

Electronic Health Records (EHR)

Job description

Advanced Medical Management, Inc. in Long Beach, California, is seeking a Utilization Management Coordinator to coordinate prior authorization requests and support utilization review activities. The candidate will work closely with health plans, providers, and internal departments to ensure compliance with CMS and DHCS regulations.

Required qualifications include a High School Diploma and at least one year of healthcare experience. The position offers a range of benefits including health coverage, paid time off, and professional development opportunities.