UM Coordinator

MagnaCare; Chapel Hill (NC); On-site; USD 45,000 - 60,000; Full time

Job summary

A leading healthcare organization in North Carolina is looking for a UM Coordinator to manage the prior authorization process. Responsibilities include verifying member eligibility and coordinating communications with providers and patients. Candidates should have a strong knowledge of medical terminology, excellent interpersonal communication skills, and attention to detail. This role demands proficiency in Microsoft Word and Excel, with a preference for candidates holding a Bachelor’s degree. Join a team dedicated to improving healthcare outcomes.

Qualifications

• Knowledge of medical record review.
• Familiarity with medical terminology essential.
• Experience with third-party payor processes preferred.
• Proficient computer skills required.

Responsibilities

• Coordinate prior authorization process for members.
• Verify member eligibility, benefit status, and provider participation.
• Maintain documentation within clinical record as per guidelines.
• Communicate effectively with internal and external customers.

Skills

Interpersonal communication

Critical thinking

Problem-solving

Customer service

Attention to detail

Education

HS diploma or GED

Bachelor's degree (preferred)

Tools

Microsoft Word

Microsoft Excel

Job description

UM Coordinator – MagnaCare

We are looking for a UM Coordinator at MagnaCare to coordinate all aspects of the prior authorization process, including member eligibility and benefit verification, gathering necessary clinical information from electronic medical records, and timely communication with members, providers, and facility staff. Candidates should possess knowledge of third‑party reimbursement regulations and medical terminology. Success in this role will require strong interpersonal communication, critical thinking, and problem‑solving skills. The successful candidate will interact and communicate effectively with internal and external customers, providers in clinical settings, and all members of the organization.

Primary Responsibilities

• Research and confirm authorization requirements and communicate to members, providers, and facility staff
• Collect data upon notification from patient/patient representative, physician, or hospital; verify member eligibility, plan participation, and provider participation status
• Create cases within the documentation system in accordance with departmental workflows, policies, and procedures
• Identify and correctly attach clinical documentation to appropriate cases within the documentation system
• Interact telephonically with members, providers, and facilities to determine requests for type of care, including inbound and outbound calls as needed
• Maintain accurate documentation within the clinical record according to workflows, policies and procedures
• Collaborate with the clinical team to address provider or member questions, issues, or concerns
• Play an active role in continuous improvement activities and quality initiatives to support positive outcomes for members, providers, and clients
• Maintain professional communication with all internal and external stakeholders

Essential Qualifications

• HS diploma or GED required
• Strong skills in medical record review
• Knowledge of CPT codes (preferred)
• Prior knowledge of JIVA (preferred)
• Excellent customer service and communication skills
• Strong attention to detail and accuracy
• Ability to define problems, obtain data, and establish facts
• Proficient computer skills (PC) with working knowledge of Microsoft Word and Excel
• Excellent data entry skills
• Bachelor’s degree preferred, but not required
• Familiarity with medical terminology required
• Familiarity with third‑party payor processes and procedures strongly desired