Utilization Management Support Specialist (Remote)

Integra Partners; United States; Remote; USD 22,000 - 30,000; Full time

Benefits offered by this job

Competitive compensation

401(k) retirement plan with company

Company-paid life insurance

Company-paid short term disability

Medical, Vision, and Dental

Paid Time Off

Paid parental leave

Sick time

Holidays and floating holidays

Quarterly events

Health and wellness programs

Career development opportunities

Job summary

Integra Partners is seeking an UM Coordinator to support the clinical team with administrative tasks related to processing Utilization Management prior authorizations and appeals. You will monitor faxes, enter authorizations in the UM platform, verify eligibility, gather documentation, and initiate appeal cases to ensure timely processing.

The role emphasizes strong organization, the ability to work in a fast-paced environment, effective communication, and collaboration with UM Nurses and

Qualifications

• 1 year as a UM Coordinator in a managed care payer environment preferred.
• Knowledge of ICD-10, HCPCS codes and medical terminology required
• Ability to prioritize multiple tasks using time management and organizational skills
• Strong computer skills with proficiency in Word, Outlook and other software applications
• Experience with DMEPOS desired
• Medicare/Medicaid experience a plus

Responsibilities

• Monitor incoming faxes
• Enter UM authorizations review requests in UM platform using ICD-10 and HCPCS codes
• Verify eligibility and claim history in proprietary claims platform
• Verify all necessary documentation has been submitted with authorization requests
• Contact requesting providers to obtain medical records or other necessary documentation related to specific UM request
• Generate correspondence and assist with faxing/mailing member and provider notifications
• Complete verbal notifications
• Document as required in authorization platform
• Initiate appeal cases and forward to UM Nurses for completion
• Meet internal and regulator deadlines for UM cases
• Complete tasks assigned by UM Nurses and document as required
• Complete inquiries received from call center and other internal & external sources
• Other duties as assigned by UM Director
• Strong organizational skills, ability to adapt quickly to change and desire to work in a fast-paced environment
• Team oriented and self-motivated with a positive attitude

Skills

UM Coordination

Documentation

Time management

Verbal communication

Verifiable references

DMEPOS knowledge

Medicare/Medicaid experience

MS Office (Word/Outlook)

Tools

Word

Outlook

Essette

Salesforce

Job description

Integra Partners is seeking an UM Coordinator to support the clinical team with administrative tasks related to processing Utilization Management prior authorizations and appeals. You will monitor faxes, enter authorizations in the UM platform, verify eligibility, gather documentation, and initiate appeal cases to ensure timely processing.

The role emphasizes strong organization, the ability to work in a fast-paced environment, effective communication, and collaboration with UM Nurses and