Ontario, CA 91761
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 multi-task with a working knowledge of ICD.9/10, CPT Coding and Medical Terminology. The 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.
Responsible for monitoring the Right Fax Server. Ensuring all referrals are processed in a timely manner and ensuring compliance with appropriate turnaround time frames.
Responsible for checking the referral form for completeness, obtaining missing demographic information as needed, and initial attempts at coding any uncoding referrals.
Responsible for meeting accuracy standards for appropriate authorizations of referrals at the UM Coordinator level.
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.
High School diploma or equivalent required. Associates degree preferred. Medical Assistant Certificate preferred.
Two (2) years of experience as a Medical Coordinator or Medical Office.
Minimum of three years of experience as a data entry specialist or coordinator, preferably in an HMO or Managed Care setting.
Knowledge of computer applications, including word processing, database and spreadsheets.
Requires knowledge of ICD-9/10 and CPT codes. Managed Care or physician office a must.
Good customer service skills.
Ability to work weekends .