Utilization & Authorization Coordinator

Community Health Choice, Inc.; Houston (TX); Hybrid; USD 42,000 - 54,000; Full time

Job summary

Community Health Choice, Inc. seeks a UM Coordinator to assist in obtaining provider authorizations and ensure accurate data entry in the Utilization Module.

You will process non-clinical service requests, admissions notifications, transfers, and home health or equipment referrals with attention to regulatory timelines. You will respond to provider hotline inquiries, route calls to the appropriate staff, and support CHC guidelines to help clinicians make informed decisions about admissions,

Qualifications

• Three (3) years of experience in Referrals/Authorization.
• At least one (1) year insurance related experience in managed care environment or equivalent.
• Experience in Medical Coding, preferred.
• Microsoft Office (Word, Excel, Outlook) proficiency.

Responsibilities

• Assist in monitoring reports and refer to UM Nurse or Manager as needed.
• Data entry of requests for authorization for admissions, transfers and other services.
• Answer provider hotline calls, schedule and route to appropriate staff, and maintain regulatory time standards.

Skills

Data entry

Communication skills

Analytical skills

Education

High School diploma or equivalent

Some college

Tools

Microsoft Office

Medical coding

Job description

Community Health Choice, Inc. seeks a UM Coordinator to assist in obtaining provider authorizations and ensure accurate data entry in the Utilization Module.

You will process non-clinical service requests, admissions notifications, transfers, and home health or equipment referrals with attention to regulatory timelines. You will respond to provider hotline inquiries, route calls to the appropriate staff, and support CHC guidelines to help clinicians make informed decisions about admissions,