Utilization Management Coordinator — Hybrid Role

KMM Technologies, Inc.; Baltimore (MD); Hybrid; USD 42,000 - 62,000; Full time

Job summary

KMM Technologies, Inc. in Baltimore, MD is hiring a Medical Management Coordinator to support Utilization Management and clinical teams in a hybrid role.

On-site training and regular office presence are required, with at least two days per week in the office. You will review medical appeals and authorization requests, manage cases in GuidingCare, coordinate medical record retrieval, and assist with reporting and data management while delivering excellent service to providers and internal

Qualifications

• Knowledge of healthcare claims processing and medical management procedures.
• Strong communication, organizational, analytical, and customer service skills.
• Basic medical terminology and managed care concepts.

Responsibilities

• Provide administrative support to Utilization Management and clinical teams.
• Review, triage, and process medical appeals and authorization requests.
• Create and maintain cases in GuidingCare and route cases for review.
• Coordinate medical record retrieval and follow up with healthcare providers for required documentation.
• Prepare medical review packets for medical directors and independent review organizations.
• Support healthcare claims inquiries, benefit verification, authorization management, and claims adjustments.
• Review incoming requests and ensure accurate documentation and timely processing.
• Maintain records, track cases, and assist with reporting and data management.
• Communicate with providers and internal teams to resolve inquiries and obtain required information.
• Perform general administrative duties, including handling telephone calls, correspondence, and on-site mailing tasks.

Skills

Healthcare claims processing

CPT ICD-10 coding

Microsoft Office

Communication skills

Organizational skills

Time management

Education

High school diploma or equivalent

Tools

GuidingCare

Facets

SharePoint

Job description

KMM Technologies, Inc. in Baltimore, MD is hiring a Medical Management Coordinator to support Utilization Management and clinical teams in a hybrid role.

On-site training and regular office presence are required, with at least two days per week in the office. You will review medical appeals and authorization requests, manage cases in GuidingCare, coordinate medical record retrieval, and assist with reporting and data management while delivering excellent service to providers and internal