UM Coordinator

Imperial Health Plan of California, Inc.; Pasadena (CA); On-site; USD 50,000 - 65,000; Full time

Job summary

A healthcare organization in Pasadena seeks a UM Coordinator for inpatient and outpatient services. This role requires processing authorizations, ensuring accuracy, and providing necessary information to medical providers. Candidates should have strong communication skills and a minimum of one year in healthcare. Duties include handling incoming faxes, customer service calls, and maintaining compliance with regulations. This role is crucial for effective healthcare delivery.

Qualifications

• High school graduate or equivalent.
• 1 year of medical office or healthcare 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.
• Provide customer service to calls from providers and/or members.
• Print approvals and modification letters from the database on a daily basis.
• Scan faxes to existing authorizations in the system.
• Route medical reviewers' cases to appropriate personnel promptly.
• Verify duplicate requests and notify the doctor's office of cancellations.
• Contact and follow up with providers on pending documents.
• Verify and update missing information before submitting for approval.
• Adhere to payroll policies and use the timekeeping system responsibly.
• Maintain regular and consistent attendance.
• Adhere to Compliance Plan and HIPAA regulations.

Education

High school graduate or equivalent

1 year of medical office or healthcare experience

Job description

JOB TITLE:

UM Coordinator Inpatient and Outpatient

DEPARTMENT:

Utilization Management

REPORTS TO:

Supervisor, Utilization Management

JOB SUMMARY:

This position processes authorizations and ensures that all information is correct before submitting for approval. All authorizations should be entered in a timely manner with complete data, as well as all the documents that will support medical necessity. The UM Coordinator will need to have strong written/communication skills in order to provide the Medical Director, providers, and members with the necessary information to ensure the delivery of high-quality, effective healthcare.

Essential Job Functions

• 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 reviewers' cases to appropriate personnel in a timely manner on a daily basis.
• Verify duplicate requests and call/notify the doctor's office of referral request cancellations.
• Contact and follow up with providers on pending clinical/documents within the turnaround time. (Routine 5 days, Urgent 72 hours).
• Verify and update all missing information (DOS, POS, outpatient or inpatient) before submitting for approval.
• Adheres to payroll policies and properly uses the timekeeping system with minimal manual changes.
• Maintains regular and consistent attendance.
• Adheres to Compliance Plan and HIPAA regulations

Education/Experience

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