Utilization Management Coordinator

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Integra Partners

πŸ’΅ $39k
πŸ“Remote - Worldwide

Job highlights

Summary

Join Integra Partners as a UM Coordinator and support the clinical team with administrative and non-clinical tasks related to utilization management. You will monitor incoming faxes, enter authorization requests, verify eligibility and documentation, contact providers, generate correspondence, complete notifications, initiate appeals, and meet deadlines. The role requires strong organizational skills, adaptability, and teamwork. Experience as a UM Coordinator in a managed care environment and knowledge of ICD-10 and HCPCS codes are essential. Integra Partners offers competitive compensation, benefits including health insurance, retirement plan, paid time off, and professional development opportunities.

Requirements

  • Knowledge of ICD-10, HCPCS codes and medical terminology
  • 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

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

Preferred Qualifications

  • 1 year as a UM Coordinator in a managed care payer environment
  • Experience with DMEPOS
  • Medicare/Medicaid experience

Benefits

  • 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

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