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UM Coordinator II

Company: Easy Care MSO, LLC
Location: Long Beach
Posted on: May 13, 2022

Job Description:

JOB TITLE: UM Coordinator II DEPARTMENT: Utilization Management CLASSIFICATION: Full Time (Exempt) REPORTS TO: Health Services Director Job Overview: The UM Coordinator is responsible for processing phone and fax authorization requests for medical services from physicians, hospitals and/or providers and Members in an efficient, accurate and customer-focused manner while ensuring compliance with federal, state, or Health Plan specific turnaround time requirements. The UM Coordinator is accountable for facilitating timely authorizations and notifications as well as other referral management functions. Essential Functions Include But Are Not Limited To: --- Effectively handles authorization requests and inquiry phone calls from providers, balancing excellent customer service with efficiency. --- Follows appropriate procedures for checking member eligibility, authorization history and provider network participation status. --- Based on the information provided by the provider and gathered from computer systems, determines the appropriate handling of each inpatient or outpatient request. --- Utilizing accepted protocol, determines authorization requirements based on the type of service requested, the location of the service, and the provider specifics. --- Utilizes authorization approval list, ancillary rosters, DOFR, and/or delegation agreements to drive decision-making --- Inputs review data into systems with minimal errors. --- Based on authorization rules and urgency, either approves the authorization request, or sends to UM Medical Director for review. --- Communicates authorization specifics to providers either verbally through phone calls or written through fax. --- Interprets a variety of instructions furnished in written and oral forms. --- Assists in preparing and submitting projects, reports or assignments as needed to meet department initiatives and/or objectives. --- Referral patient to CCS when appropriate and open/document case in portal system. --- Performs other duties as assigned. --- Performs trouble-shooting when problems situations arise --- Ensure timely provider and member oral and written notification of referral decisions. --- Utilizes authorization protocols, ancillary rosters, DOFR, and/or delegation agreements to drive decision-making --- Facilitates LOA processing by sending request to Provider Contracting for non-contracted providers or facilities, when applicable --- Facilitates LOA processing with the Health Plan for non-contracted facilities --- Maintain Inter-rater reliability score of 95% Additional Responsibilities: --- Make suggestions for improvement within the department and implement suggestions. Qualifications: --- High School Diploma --- Minimum 1 year related customer service, administrative or related experienced required; or an equivalent combination of education, training and experience. --- Ability to work from designated office for collaborative/interactive fulfillment of duties; concentrate in an open-office cubicle environment --- Perform telephone and/or computer work for extended periods of time --- Ability to read and interpret medical documents --- Operates office equipment such as computer, telephone and copy/scan/fax machine --- Knowledge of HIPAA Guidelines including the PHI privacy requirements. --- Highly detail oriented and ability to review documents and follow the specific requirements. Education: --- High School Diploma Certification/Licensure: --- None required for this position Experience: --- Minimum one 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 gov Job Requirements:

  • Skills:
  • Ability to establish a compassionate environment by engaging and calmly discussing difficult patient issues
  • Excellent verbal and communication skills, ability to analyze and problem solve
  • Knowledge of CPT, ICD-10 Coding and medical terminology
  • Ability to type a min. of 30 words per minute.
  • Knowledge of computer skills in word, processing authorization systems and Excel.
  • Workable Knowledge of State and Federal regulations, HMO, PPO, and Utilization processes applicable to the position and ICE required compliance timeframes.
  • Maintains strict confidence of client information, ensuring client's privacy, and does not discuss internal business with external entities.
  • Managing multiple priorities, demonstrated by ease and productivity to transition between multiple tasks. -
  • -
  • Physical Requirements:
  • --- Work is sedentary, involving sitting at a PC and typing for extended periods of time, with some occasional lifting, carrying (up to 10lbs), some bending.
  • --- The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms
  • --- Frequent talking and hearing one-one-one, via phone and in groups.

Keywords: Easy Care MSO, LLC, Long Beach , UM Coordinator II, Other , Long Beach, California

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