Utilization Management Coordinator
Integra Partners, Lansing, MI, United States
The UM Coordinator assists and supports the clinical team (UM Nurses/Medical Director) with administrative and non-clinical tasks related to processing Utilization Management prior authorization and appeals.
Job Responsibilities
Monitor incoming faxes
Enter UM authorizations review requests in UM platform using ICD-10 and HCPCS codes
Verify eligibility and claim history in proprietary claims platform
Verify all necessary documentation has been submitted with authorization requests
Contact requesting providers to obtain medical records or other necessary documentation related to specific UM request
Generate correspondence and assist with faxing/mailing member and provider notifications
Complete verbal notifications
Document as required in authorization platform
Initiate appeal cases and forward to UM Nurses for completion
Meet internal and regulator deadlines for UM cases
Complete tasks assigned by UM Nurses and document as required
Complete inquiries received from call center and other internal & external sources
Other duties as assigned by UM Director
Strong organizational skills, ability to adapt quickly to change and desire to work in a fast-paced environment
Team oriented and self-motivated with a positive attitude
Pay: $19.00/hour
What will you learn in the first 6 months?
Verbal notifications
How to work in authorization systems Essette and Salesforce
Incoming/outgoing faxing process
Understanding the expectations and functions of the UM team
Time Management
What will you achieve in the first 12 months?
Expand knowledge of ICD-10 and HCPC codes
Maintaining expected timelines
Experience
1 year as a UM Coordinator in a managed care payer environment preferred
Knowledge of ICD-10, HCPCS codes and medical terminology required
Ability to prioritize multiple tasks using time management and organizational skills
Strong computer skills with proficiency in Word, Outlook and other software applications
Ability to collect data, establish facts and draw valid conclusions
Effective written and oral communication skills
Experience with DMEPOS desired
Medicare/Medicaid experience a plus
Benefits Offered
Competitive compensation and annual bonus program
401(k) retirement program with company match
Company-paid life insurance
Company-paid short term disability coverage (location restrictions may apply)
Medical, Vision, and Dental benefits
Paid Time Off (PTO)
Paid Parental Leave
Sick Time
Paid company holidays and floating holidays
Quarterly company-sponsored events
Health and wellness programs
Career development opportunities
Remote Opportunities
We are actively seeking new colleagues in: Arizona, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Kentucky, Massachusetts, Michigan, North Carolina, Nevada, New Jersey, New York, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Washington.
Integra Partners is an equal opportunity employer. We are committed to providing reasonable accommodations and will work with you to meet your needs. If you are a person with a disability and require assistance during the application process, please don’t hesitate to reach out. We celebrate our inclusive work environment and welcome members of all backgrounds and perspectives.
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Job Responsibilities
Monitor incoming faxes
Enter UM authorizations review requests in UM platform using ICD-10 and HCPCS codes
Verify eligibility and claim history in proprietary claims platform
Verify all necessary documentation has been submitted with authorization requests
Contact requesting providers to obtain medical records or other necessary documentation related to specific UM request
Generate correspondence and assist with faxing/mailing member and provider notifications
Complete verbal notifications
Document as required in authorization platform
Initiate appeal cases and forward to UM Nurses for completion
Meet internal and regulator deadlines for UM cases
Complete tasks assigned by UM Nurses and document as required
Complete inquiries received from call center and other internal & external sources
Other duties as assigned by UM Director
Strong organizational skills, ability to adapt quickly to change and desire to work in a fast-paced environment
Team oriented and self-motivated with a positive attitude
Pay: $19.00/hour
What will you learn in the first 6 months?
Verbal notifications
How to work in authorization systems Essette and Salesforce
Incoming/outgoing faxing process
Understanding the expectations and functions of the UM team
Time Management
What will you achieve in the first 12 months?
Expand knowledge of ICD-10 and HCPC codes
Maintaining expected timelines
Experience
1 year as a UM Coordinator in a managed care payer environment preferred
Knowledge of ICD-10, HCPCS codes and medical terminology required
Ability to prioritize multiple tasks using time management and organizational skills
Strong computer skills with proficiency in Word, Outlook and other software applications
Ability to collect data, establish facts and draw valid conclusions
Effective written and oral communication skills
Experience with DMEPOS desired
Medicare/Medicaid experience a plus
Benefits Offered
Competitive compensation and annual bonus program
401(k) retirement program with company match
Company-paid life insurance
Company-paid short term disability coverage (location restrictions may apply)
Medical, Vision, and Dental benefits
Paid Time Off (PTO)
Paid Parental Leave
Sick Time
Paid company holidays and floating holidays
Quarterly company-sponsored events
Health and wellness programs
Career development opportunities
Remote Opportunities
We are actively seeking new colleagues in: Arizona, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Kentucky, Massachusetts, Michigan, North Carolina, Nevada, New Jersey, New York, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Washington.
Integra Partners is an equal opportunity employer. We are committed to providing reasonable accommodations and will work with you to meet your needs. If you are a person with a disability and require assistance during the application process, please don’t hesitate to reach out. We celebrate our inclusive work environment and welcome members of all backgrounds and perspectives.
#J-18808-Ljbffr