UM Coordinator

Job Description

Job Description

JOB TITLE: UM Coordinator - Outpatient

DEPARTMENT: Utilization Management

REPORTS TO: Supervisor, Utilization Management

JOB SUMMARY: This position processes authorizations and ensures that all information is correct before submitting for approval. All authorizations should be entered in a timely manner with complete data, as well as all the documents that will support medical necessity. The UM Coordinator will need to have strong written/communication skills in order to provide the Medical Director, providers, and members with the necessary information to ensure the delivery of high-quality, effective healthcare.

ESSENTIAL JOB FUNCTIONS:

1. Open and process UM incoming faxes periodically throughout the business day.
2. Answer phones: Providing customer service to calls from providers and/or members.
3. Print approvals and modification letters from the database on a daily basis.
4. Scan any faxes to existing authorizations in the system.
5. Route medical reviewers' cases to appropriate personnel in a timely manner on a daily basis.
6. Verify duplicate requests and call/notify the doctor's office of referral request cancellations.
7. Contact and follow up with providers on pending clinical/documents within the turnaround time. (Routine 5 days, Urgent 72 hours).
8. Verify and update all missing information (DOS, POS, outpatient or inpatient) before submitting for approval.
9. Adheres to payroll policies and properly uses the timekeeping system with minimal manual changes.
10. Maintains regular and consistent attendance.
11. Adheres to Compliance Plan and HIPAA regulations

EDUCATION/EXPERIENCE:

• High school graduate or equivalent.
• 1 year of medical office or healthcare experience required
• Must have experience in making outgoing phone calls as well as taking incoming phone inquiries