UM Coordinator - Healthcare Authorization Specialist

Imperial Health Plan; Pasadena (CA); On-site; USD 28,000 - 30,000; Full time

Job summary

Imperial Health Plan in Pasadena, CA is seeking a UM Coordinator to process authorizations and ensure data accuracy for approvals. You will handle incoming faxes, respond to providers and members by phone, and print or scan documents to support medical necessity.

Responsibilities include routing cases to medical reviewers, verifying information such as DOS and POS, and maintaining timely follow-ups with providers while adhering to HIPAA and compliance policies.

Qualifications

• High school diploma or equivalent.
• 1 year of medical office or healthcare experience required.
• Must have experience 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 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 minimalmanual changes.
• Maintains regular and consistent attendance.
• Adheres to Compliance Plan and HIPAA regulations

Skills

Communication skills

Phone support

Data entry accuracy

Education

High school diploma or equivalent

Job description

Imperial Health Plan in Pasadena, CA is seeking a UM Coordinator to process authorizations and ensure data accuracy for approvals. You will handle incoming faxes, respond to providers and members by phone, and print or scan documents to support medical necessity.

Responsibilities include routing cases to medical reviewers, verifying information such as DOS and POS, and maintaining timely follow-ups with providers while adhering to HIPAA and compliance policies.