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Coordinator I, Utilization Mgt

Company: North American Staffing Group
Location: Montebello
Posted on: May 16, 2022

Job Description:

Job DescriptionMedica Talent Group is excited to share this direct-hire opportunity with you! Our client, a reputable community-based health care organization in Los Angeles County is seeking a UM Coordinator to join their growing team. This is a wonderful opportunity for an individual seeking to expand their knowledge in managed care. This organization offers a competitive salary, full benefits, and much more!Overview:This position is responsible for providing support to the Medical Management department to ensure timeliness of outpatient or inpatient referral/authorization processing per state and federal guidelines. This position performs trouble-shooting when problems situations arise and coordinates with leadership.Qualifications:- High School Diploma or equivalent required. - MA or Medical Billing Certificate preferred. - Minimum 1 year of experience working in a medical billing environment (IPA or HMO preferred), with pre-authorizations and reimbursement regulations pertaining to Medi-Cal, CCS and other government programs required. - Prior experience working in a clinic/health care specialty call center. - Prefer experience in utilization management processing authorization referrals.Responsibilities:- Input data into the Medical Management system to ensure timeliness of referral/authorization processing. - Verifies member benefits and eligibility upon receipt of the treatment authorization request. - Utilizes authorization matrix, ancillary rosters, DOFR, and/or delegation agreements to drive decision-making. - Coordinates with referral nurse and/or Medical Director for timely referral processing. - Ensure timely provider and member oral and written notification of referral decisions. - Ensures proper notification of patient facility admissions with PCP and NOMNC when applicable. - Coordinate board certified referrals with partner vendors. - Coordinates and assists with patient appointments as needed and notify patient of authorization status. - Performs trouble-shooting when problems situations arise and coordinates with leadership. - Prepares denial letters for review by Medical Director or Nurse Reviewer(s) and distributes letters to appropriate recipients. - Demonstrates excellent communications skills and interpersonal relationships. - Collaborates and facilitates interdisciplinary team communications. - Perform additional duties as assigned. - Process referrals within the dept. targets based on workflows and technology. - Meets inter-rater minimum standards for core responsibilities.

Skills and Abilities:- Knowledge of medical terminology and coding (e.g., ICD-10, CPT, HCPCS). - Knowledge of the health care industry, preferably managed care. - Knowledge of computer skills in word processing, authorization systems and spreadsheets. - Ability to type a min. of 30 words per minute. - Knowledge of HIPAA Guidelines including the PHI privacy requirements. - Exceptional organizational skills. - Bilingual English/Spanish preferred.INDMED

Keywords: North American Staffing Group, Montebello , Coordinator I, Utilization Mgt, Other , Montebello, California

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