Coordinator - Utilization Management Outpatient

Location: Rancho Cucamonga, California/ some work-from-home days

Schedule: Monday through Friday 8a-5p

Pay: 23.98/hour

Requirements: coordinator experience, high school diploma or equivalent, ICD10/CPT coding

Job Type: Full time 40 hours/week 6-month contract

Summary:

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 that one be organized, ability to multitask with 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 in an accurate and timely manner while always maintaining highest level of customer service, in addition to collaboration with, inter-departments to ensure member needs are met while simultaneously building strong peer relationships.

Responsibilities:

1. Responsible for monitoring the Right Fax Server.  Ensuring all referrals are processed in a timely manner and ensuring compliance with appropriate turnaround timeframes.


2. Responsible for checking the referral form for completeness, obtaining missing demographic information as needed, and initial attempts at coding any uncoded referrals.


3. Responsible for meeting accuracy standards for appropriate authorizations of referrals at the UM Coordinator level.


4. Responsible for answering the calls for the Utilization Management Department in a friendly and professional manner.


5. 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.


6. Assist Management or Utilization Management Nurses as requested.

Education & Requirements 

• Minimum of three (3) years of experience as a data entry specialist or coordinator
  
  
  
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    Experience as a data entry specialist or coordinator preferably in an HMO or Managed Care setting

    
    
  
  
  
  


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  High school diploma or GED required

  
  
  
  
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    Associate's degree or Bachelor's degree from an accredited institution preferred

    
    
  
  
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    Medical Assistant certificate preferred

    
    
  
  
  
  

Key Qualifications

• Requires knowledge of ICD-9/10 and CPT codes


• Managed Care or physician office experience a must


• Skilled in computer applications, including word processing, database, and spreadsheets


• Good customer service skills


• While performing the duties of this job, team member is occasionally required to stand; walk; sit; use hands to finger, handle or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk or hear; and use taste or smell


• The team member must occasionally lift or move up to 25 pounds


• Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus