UM Outpatient Coordinator

Ontario, CA 91761

Posted: 11/12/2018 Job Category: Admin/Clerical Job Number: 1802994 Pay Rate: $16.41/hour
UM Outpatient Coordinator
Kinetic Personnel Group is currently recruiting for an UM Outpatient Coordinator for a public health agency that has won awards for its quality-of-work-and-life-balance. This four-billion-dollar non-profit company also offers CalPERS benefits on the full-time side. 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.
Job Duties
  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 representing the company in a friendly and professional manner while answering the calls for the Utilization Management Department.
  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.
  7. Any other duties as required ensuring plan operations are successful.
Requirements (must have):
  • Possession of a high school diploma or equivalent.
  • Minimum of three 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.
Preferred (like to have):
  • 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.
  • Type 45 WPM.
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