Utilization Management Coordinator I

altamed; Commerce (CA); On-site; USD 37,000 - 46,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

403(b) retirement

Flexible Spending Accounts

Paid Time Off

CME days

Malpractice tail coverage

Tuition reimbursement

Employee discounts

Pet care insurance

Job summary

AltaMed Health Services Corp. is seeking a medical billing/authorization specialist to support the Senior Care Services/PACE department. You will ensure timely processing of referrals and authorizations in line with state and federal guidelines.

The role requires 1+ year in a medical billing setting (IPA/HMO preferred), familiarity with Medi-Cal/CCS programs, and experience in a clinic call center. Strong troubleshooting and coordination with leadership are essential.

Qualifications

• Minimum 1 year of experience in a medical billing environment (IPA or HMO preferred) with pre-authorizations and reimbursement regulations with Medi-Cal, CCS, and other government programs.
• Prior experience working in a clinic/health care specialty call center.
• Prefer experience in utilization management, processing authorization referrals.

Responsibilities

• Support the Senior Care Services/PACE department to ensure timeliness of outpatient or inpatient referral/authorization processing per state and federal guidelines.
• Perform troubleshooting when problem situations arise.
• Coordinate with leadership to resolve issues and streamline processes.

Skills

Medical billing experience

Pre-authorizations

Clinic call center

Utilization management

Authorization referrals

Education

High School Diploma or equivalent

Medical Billing Certificate

Job description

Grow Healthy

If you are as passionate about helping those in need as you are about growing your career, consider AltaMed. At AltaMed, your passion for helping others isn’t just welcomed – it’s nurtured, celebrated, and promoted, allowing you to grow while making a meaningful difference. We don’t just serve our communities; we are an integral part of them. By raising the expectations of what a community clinic can deliver, we demonstrate our belief that quality care is for everyone. Our commitment to providing exceptional care, despite any challenges, goes beyond just a job; it’s a calling that drives us forward every day.

Job Overview

This position supports the Senior Care Services/PACE department to ensure the timeliness of outpatient or inpatient referral/authorization processing per state and federal guidelines. This position performs troubleshooting when problem situations arise and coordinates with leadership.

Minimum Requirements

• High School Diploma or equivalent required.
• MA or Medical Billing Certificate preferred.
• Minimum 1 year of experience working in a medical billing environment (IPA or HMO preferred), with pre-authorizations and reimbursement regulations with Medi-Cal, CCS, and other government programs required.
• Prior experience working in a clinic/health care specialty call center.
• Prefer experience in utilization management, processing authorization referrals.

Compensation

$26.91 - $33.53 hourly

Compensation Disclaimer

Actual salary offers are considered by various factors, including budget, experience, skills, education, licensure and certifications, and other business considerations. The range is subject to change. AltaMed is committed to ensuring a fair and competitive compensation package that reflects the candidate's value and the role's strategic importance within the organization. This role may also qualify for discretionary bonuses or incentives.

Benefits & Career Development

• Medical, Dental and Vision insurance
• 403(b) Retirement savings plans with employer matching contributions
• Flexible Spending Accounts
• Commuter Flexible Spending
• Career Advancement & Development opportunities
• Paid Time Off & Holidays
• Paid CME Days
• Malpractice insurance and tail coverage
• Tuition Reimbursement Program
• Corporate Employee Discounts
• Employee Referral Bonus Program
• Pet Care Insurance

Job Advertisement & Application Compliance Statement

AltaMed Health Services Corp. will consider qualified applicants with criminal history pursuant to the California Fair Chance Act and City of Los Angeles Fair Chance Ordinance for Employers. You do not need to disclose your criminal history or participate in a background check until a conditional job offer is made to you. After making a conditional offer and running a background check, if AltaMed Health Service Corp. is concerned about a conviction directly related to the job, you will be given a chance to explain the circumstances surrounding the conviction, provide mitigating evidence, or challenge the accuracy of the background report.