Position
Utilization Management Outpatient Coordinator
Position Overview
Are you an organized individual with a knack for multitasking and a strong understanding of medical terminology and coding?
We are looking for a dedicated professional to join our team as an Outpatient Utilization Management Coordinator. In this high-paced role, you will play a crucial part in processing authorization requests, verifying eligibility, and supporting our Medical and Utilization Management Nurses.
Your ability to maintain the highest level of customer service while handling provider calls will be essential to your success in this position.
Key Responsibilities
Monitor the Right Fax Server to ensure all referrals are processed in a timely manner, adhering to appropriate turnaround timeframes.
Check referral forms for completeness, obtain missing demographic information, and make initial attempts at coding any uncoded referrals.
Meet accuracy standards for appropriate authorizations of referrals at the UM Coordinator level.
Represent the Inland Empire Health Plan in a friendly and professional manner while answering calls for the Utilization Management Department.
Communicate with providers, in consultation with the Utilization Management Nurse, regarding authorizations, modifications, denials, and other matters pertinent to processing authorization requests or other UM-related correspondence.
Assist Management or Utilization Management Nurses as requested.
Requirements
Minimum of three (3) years of experience as a data entry specialist or coordinator.
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 preferred.
Medical Assistant certificate preferred.
Knowledge of ICD-9 / 10 and CPT codes is essential. Experience in Managed Care or a physician's office is a must.
Proficiency in computer applications, including word processing, database, and spreadsheets. Excellent customer service skills.
INDH
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