Utilization Management Coordinator: Data & Authorization

Harris Health System, Inc.; Houston, Northern (TX, KY); Hybrid; USD 42,000 - 54,000; Full time

Job summary

Community Health Choice, Inc. in Houston seeks a UM Coordinator to assist CHC providers with authorization and data entry in the Utilization Module. You will handle admissions notifications, transfers, and home health requests, supporting clinical staff and Medical Directors in decision making.

You will monitor data, ensure timely processing of requests, and maintain regulatory timelines while supporting regulatory guidelines and quality standards.

Qualifications

• Education/Specialized Training/Licensure: High School or equivalent.
• Some years of college, preferred.
• Three (3) years of experience Referrals/Authorization. required.
• At least one (1) year insurance related experience in managed care environment or equivalent required.
• Experience in Medical Coding, preferred.
• Software Proficiencies: Microsoft Office (Word, Excel, Outlook)

Responsibilities

• Assists in monitoring reports and refers to appropriate UM Nurse or Manager.
• Data entry of requests for authorization for admissions, notification of deliveries, sick newborns, and other services.
• Obtains all pertinent information and medical codes related to the admission, transfer, out of network provider, route of transport, type of service, type of durable medical equipment and other key information.
• Data entry and processing of fax and telephone requests to meet performance and quality standards while maintaining regulatory timeframes.
• Responds to calls from the provider hotline for referral/authorization initiation and questions.
• Answers in a timely and professional manner.
• Forwards calls to appropriate nursing or medical staff as required or needed.
• Forwards calls efficiently to other departments when appropriate.
• Responsible for ensuring that provider hotline calls are answered within established regulatory time standards to minimize hold time and avoid abandoned calls.
• Meets required call handling standards and quality reviews.
• Actively contributes to achievement of departmental goals, as identified in Department's annual business plan, including specific departmental process improvement plans and other duties as assigned.

Skills

Data entry

Communication

Phone screening

Regulatory timelines

Education

High School or equivalent

Some college

Tools

Microsoft Office

Job description

Community Health Choice, Inc. in Houston seeks a UM Coordinator to assist CHC providers with authorization and data entry in the Utilization Module. You will handle admissions notifications, transfers, and home health requests, supporting clinical staff and Medical Directors in decision making.

You will monitor data, ensure timely processing of requests, and maintain regulatory timelines while supporting regulatory guidelines and quality standards.