UM Outpatient Coordinator
Ontario, CA 91761
- Responsible for monitoring the Right Fax Server. Ensuring all referrals are processed in a timely manner and ensuring compliance with appropriate turnaround timeframes.
- Responsible for checking the referral form for completeness, obtaining missing demographic information as needed, and initial attempts at coding any uncoded referrals.
- Responsible for meeting accuracy standards for appropriate authorizations of referrals at the UM Coordinator level.
- Responsible for representing the company in a friendly and professional manner while answering the 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.
- Any other duties as required ensuring plan operations are successful.
- Possession of a high school diploma or equivalent.
- Minimum of two years of experience as a data entry specialist or coordinator, preferably in an HMO or Managed Care
- Requires knowledge of ICD-9/10 and CPT codes.
- Type 35 WPM
- Medical Assistant Certification, Associate or Bachelor s degree from an accredited institution.
- Managed care setting experience preferred. Knowledge of Utilization Management including referral process, ICD-10 and CPT codes.