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UM Coordinator
UM CoordinatorAdvanced Medical Management • Long Beach, CA, US
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UM Coordinator

UM Coordinator

Advanced Medical Management • Long Beach, CA, US
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Job Description

Job Description

POSITION SUMMARY

Reports to Clinical Operations Manager. The Utilization Management Coordinator is responsible for processing and assisting with 80-100 authorizations per day, reviewing authorizations for accuracy such as completeness which includes correct address, correct provider, all appropriate CPT codes, ICD-10 codes, and correct place of service / facility. Individuals must be able to execute effective communications verbally and in writing. Maintain patient confidentiality and promote departmental and organizational goals.

RESPONSIBILITIES-DUTIES

  • Individuals will be available to assist Licensed Nursing staff with non-clinical tasks associated with the processing of prior authorizations but primarily assist other outpatient UM staff with daily tasks.
  • If a member is not in the system, notifies eligibility by submitting member inquiry.
  • Provides benefit and or guideline information to the authorization, Information is uploaded onto the authorization prior to passing to the clinical review UM Nurse, and / or Medical Director.
  • Calls providers to obtain the supporting medical documentation needed for Prior Auth Nurse, and / or Medical Director to review.
  • Educates providers as needed with the Authorization / Referral process under the direction on Admin Authorization Supervisor and Outpatient Prior Authorization Coordinator, II & III.
  • Maintains confidentiality of all members and medical / clinical information.
  • Performs as necessary to any departmental changes, workload and / or emergencies.
  • Understands UM Policies / Procedures.
  • Ensures the privacy and security of PHI(Protected Health Information)as outlined in AMM policies and procedures relating to HIPPA compliance.
  • Performs other duties as directed by Admin Auth Supervisor and / or UM Director.

EDUCATION & EXPERIENCE REQUIREMENTS

  • At least one year of related experience and / or training; or equivalent combination of education and experience preferred.
  • Medical terminology training, medical or other healthcare related experience preferred. May be required to take additional training classes during first six months of employment.
  • High school diploma or GED
  • Must be able to communicate both orally and in writing.
  • Ability to apply common sense, to read and comprehend simple to moderate instructions to carry out basic to detailed written and / or oral instructions.
  • Must be able to efficiently prioritize multiple high priority tasks and or follow a set level of tasks assigned.
  • Must have the ability to work as a team player, take instructions and follow through with tasks. Must also be able to follow simple instructions and be organized but requires moderate to minimal supervision.
  • Must maintain strict confidentiality of all patient information and IPA business.
  • AMM BENEFITS

    When you join AMM, you’re not just getting a job—you’re getting a benefits package that puts YOU first :

  • Health Coverage You Can Count On : Full employer-paid HMO and the option for a flexible PPO plan .
  • Wellness Made Affordable : Discounted vision and dental premiums to help keep you healthy from head to toe.
  • Smart Spending : FSAs to manage healthcare and dependent care costs, plus a 401(k) to secure your future.
  • Work-Life Balance : Generous PTO , 40 hours of sick pay , and 13 paid holidays to enjoy life outside of work.
  • Career Development : Tuition reimbursement to support your education and growth.
  • Team Fun : Paid company outings and lunches because we work hard, but we also know how to have fun!
  • Join AMM and experience a workplace where your health, growth, and happiness comes first!

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    Um Coordinator • Long Beach, CA, US

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