UM Care Coordinator: Healthcare Authorization

Evolving Solution Services; Pasadena (CA); On-site; USD 20,000 - 26,000; Full time

Job summary

Evolving Solution Services in Pasadena, CA is seeking a UM Coordinator to process authorizations and verify data before submission for approval. The role requires strong written and verbal communication with Medical Directors, providers, and members to ensure timely, high-quality healthcare decisions.

Key duties include opening and processing faxes, answering calls, printing approvals, scanning documents, routing cases, and updating critical details like DOS and outpatient/inpatient status.

Qualifications

• High school graduate or equivalent.
• 1 year of experience required.
• Must have experience in making outgoing phone calls as well as taking incoming phone inquiries.

Responsibilities

• Open and process UM incoming faxes periodically throughout the business day.
• Answer phones: Providing customer service to calls from providers and/or members.
• Print approvals and modification letters from the database on a daily basis.
• Scan any faxes to existing authorizations in the system.
• Route medical reviewer’s cases to appropriate personnel in timely manner on a daily basis.
• Verify duplicate requests and call/notify doctor's office of referral request cancellations.
• Contact and follow up with providers on pending clinical/documents within the turnaround time.
• Verify and update all missing information before submitting for approval.
• Adheres to payroll policies and properly uses timekeeping system with minimal manual changes.
• Maintains regular and consistent attendance.
• Adheres to Compliance Plan and HIPAA regulations.

Skills

English communication

Phone handling

Customer service

Confidentiality

Time management

Multitasking

Regulatory compliance understanding

Professional interaction

Education

High school diploma or equivalent

Tools

Microsoft Office

Job description

Evolving Solution Services in Pasadena, CA is seeking a UM Coordinator to process authorizations and verify data before submission for approval. The role requires strong written and verbal communication with Medical Directors, providers, and members to ensure timely, high-quality healthcare decisions.

Key duties include opening and processing faxes, answering calls, printing approvals, scanning documents, routing cases, and updating critical details like DOS and outpatient/inpatient status.