UM Referral Coordinator

CommonSpirit Health; Bakersfield (CA); Remote; Full time

Job summary

CommonSpirit Health is seeking a UM Referral Coordinator to manage prior authorization referrals. This work-from-home role requires experience in healthcare, proficiency in coding, and effective communication skills. The position offers a competitive hourly rate and comprehensive benefits.

Benefits

Health benefits

Dental benefits

Vision benefits

Retirement plans

Paid time off

Qualifications

• 3 years experience in healthcare or related fields.
• Proficiency in coding (CPT, ICD-10, HCPCS).
• Effective communication skills with staff and providers.

Responsibilities

• Processing authorization requests according to policy.
• Verifying member eligibility and benefits.
• Communicating with providers and members regarding outcomes.

Skills

Communication

Problem Solving

Attention to Detail

Education

High school diploma or equivalent

Tools

Microsoft Office

EZCap

Job description

Join to apply for the UM Referral Coordinator role at CommonSpirit Health.

Position Summary

The position is responsible for reviewing and processing daily prior authorization referrals according to written criteria, policies, and procedures. It considers eligibility, benefits, medical necessity, and appropriate providers to decide the disposition of a referral. The role involves daily/weekly contact with UM staff, Physician Reviewers, providers, health plans, and other staff. The coordinator has the authority to authorize medical services using medical policy guidelines and must refer requests that do not meet these guidelines to RN or Physician reviewers. The role requires working independently on assigned tasks based on established policies.

Responsibilities May Include

• Processing authorization requests according to company/department policy and standards.
• Verifying member eligibility and benefits using health plan guidelines.
• Verifying procedures and diagnoses, coding them appropriately (CPT, ICD-10, HCPCS).
• Ensuring accuracy of information in EZCap and the Utilization Management workflow, making updates as necessary.
• Responding professionally to authorization inquiries and providing accurate information.
• Communicating with providers and members regarding authorization outcomes.
• Drafting basic correspondence related to authorizations.
• Collaborating with internal departments to gather information or documentation needed for processing authorizations.

Qualifications

Minimum Qualifications

• At least three years of experience in healthcare or related fields involving authorizations, medical assisting, or billing.
• High school diploma or equivalent.
• Proficiency in Microsoft Office, Outlook, and general office procedures.
• Knowledge of CPT, ICD-10, HCPCS coding, and medical terminology related to healthcare plans.
• Effective communication skills with all levels of staff, management, and providers.
• Strong problem-solving skills and attention to detail.

Preferred Qualifications

• Knowledge of EZCap and electronic practice management systems.
• Completion of medical assisting or billing vocational programs.
• Experience in managed care environments and familiarity with medical terminology.

Additional Information

This position is a work-from-home role within California and offers a pay range of $23.00 to $27.99 per hour. Dignity Health MSO provides comprehensive benefits, including health, dental, vision, retirement plans, and paid time off.