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Role Description

This role involves supporting the clinical team by handling administrative and non-clinical tasks essential for processing Utilization Management prior authorizations and appeals.

• Monitor incoming faxes for authorization requests
• Enter UM authorizations review requests using ICD-10 and HCPCS codes
• Verify eligibility and claims history in proprietary platforms
• Ensure all necessary documentation is submitted with authorization requests
• Contact providers to obtain required medical records
• Generate correspondence for member and provider notifications
• Complete verbal notifications and document activities
• Initiate appeal cases for UM Nurses
• Meet deadlines for UM cases as per internal and regulatory standards
• Assist UM Nurses with designated tasks
• Handle inquiries from call center and other sources
• Perform other duties assigned by the UM Director

Qualifications

• 1 year as a UM Coordinator in a managed care payer environment preferred
• Knowledge of ICD-10, HCPCS codes, and medical terminology required
• Strong time management and organizational skills to prioritize tasks
• Proficient in computer applications like Word and Outlook
• Ability to collect data, analyze facts, and draw valid conclusions
• Effective written and oral communication skills required
• Experience with DMEPOS is desired
• Medicare/Medicaid experience is a plus

Benefits

• Competitive compensation and annual bonus program
• 401(k) retirement program with company match
• Company-paid life insurance and short-term disability coverage
• Medical, Vision, and Dental benefits
• Paid Time Off (PTO) and Paid Parental Leave
• Sick Time and Paid company holidays
• Quarterly company-sponsored events
• Health and wellness programs
• Career development opportunities