Utilization Management Outpatient Coordinator (Hybrid - Temporary)

Inland Empire Health Plan; Rancho Cucamonga (CA); Hybrid; USD 80,000 - 100,000; Full time

Job summary

Join a dynamic and forward-thinking organization dedicated to healing and inspiring the human spirit. This temporary role as an Outpatient UM Coordinator involves supporting the Utilization Management team by processing authorization requests and ensuring high-quality customer service. With a focus on accuracy and efficiency, you'll play a vital role in managing referrals and communicating with healthcare providers. This position offers a unique opportunity to gain experience in the healthcare sector while working in a hybrid model that balances in-office and remote work. If you're passionate about making a difference in people's lives, this role is for you!

Qualifications

• 3+ years of experience in data entry, preferably in HMO or Managed Care.
• Knowledge of ICD-9/10 and CPT codes is essential.

Responsibilities

• Monitor the Right Fax Server for prompt processing of referrals.
• Ensure accuracy in referral authorizations and respond to provider calls.

Skills

ICD-9/10 Coding

CPT Coding

Customer Service

Data Entry

Multitasking

Education

High School Diploma or GED

Associate's Degree

Bachelor's Degree

Medical Assistant Certificate

Tools

Word Processing Software

Databases

Spreadsheets

Job description

Overview

This position is a temporary role facilitated through one of our contracted agencies and is not a direct employment opportunity with IEHP. The contracted agency offers an assignment length of up to six months, during which the candidate will provide support for IEHP.

What you can expect!

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!

Under the general direction of the UM Outpatient Manager and Supervisor, the Outpatient UM Coordinator is a high-paced position that requires timely processing of authorization requests, verifying eligibility, and obtaining additional information as requested by Medical Management or Utilization Management Nurses. This position requires organization, multitasking abilities, and a working knowledge of ICD-9/10, CPT Coding, and Medical Terminology. The Outpatient UM Coordinator will also ensure that provider calls are responded to accurately and promptly while maintaining the highest level of customer service.

Commitment to Quality: The IEHP Team is dedicated to incorporating IEHP’s Quality Program goals, including HEDIS, CAHPS, and NCQA Accreditation.

Key Responsibilities

1. Monitor the Right Fax Server to ensure all referrals are processed promptly and in compliance with turnaround timeframes.
2. Check referral forms for completeness, obtain missing demographic information, and attempt initial coding on uncoded referrals.
3. Maintain accuracy standards for appropriate referral authorizations at the UM Coordinator level.
4. Represent the Inland Empire Health Plan professionally and courteously when answering calls for the Utilization Management Department.
5. Communicate with providers in consultation with the Utilization Management Nurse regarding authorizations, modifications, denials, and other related matters.
6. Assist Management or Utilization Management Nurses as needed.

Qualifications

Education & Requirements

• Minimum of three (3) years of experience as a data entry specialist or coordinator, preferably in an HMO or Managed Care setting.
• High school diploma or GED required.
• Associate's degree or Bachelor's degree from an accredited institution is preferred.
• Medical Assistant certificate is preferred.

Key Qualifications

• Knowledge of ICD-9/10 and CPT codes.
• Managed Care or physician office experience is required.
• Proficiency in computer applications, including word processing, databases, and spreadsheets.
• Excellent customer service skills.
• Physical requirements include occasional standing, walking, sitting, handling objects, reaching, climbing stairs, balancing, stooping, kneeling, crouching, crawling, talking, hearing, and using taste or smell.
• Ability to occasionally lift or move up to 25 pounds.
• Specific vision abilities include close, distance, color, peripheral, depth perception, and focus adjustment.

Start your journey towards a thriving future with IEHP and apply TODAY!

Work Model Location

Hybrid (Positions approved for telecommuting or hybrid work may require periodic reporting to IEHP’s main campus for meetings or other needs as determined by leadership).

Pay Range

USD $23.98 - USD $23.98 /Hr.