UM Coordinator 25-00431
Alura Workforce Solutions
Rancho Cucamonga, CA
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JOB DETAILS
LOCATION
Rancho Cucamonga, CA
POSTED
30+ days ago
UM Coordinator/Delegation Oversight Specialist
Position Type: Temporary
Schedule: M-F, 8:00 am - 5:00 pm (Hybrid)
Assignment Length: Approximately 6-Months, possibly longer.
DESCRIPTION
Under the general direction of the UM Operations Manager, the Delegation Oversight Specialist is responsible for supporting the auditing and monitoring functions for delegated Independent Physician Associations (IPAs) and subcontractors. This includes planning and conducting preliminary audits to ensure adherence to performance standards and compliance with regulatory requirements including NCQA, DHMC, DHCS, and CMS.
This role involves extensive collaboration across departments, accurate documentation, and coordination of delegation oversight activities to help drive quality outcomes in a managed care setting
KEY RESPONSIBILITIES
- Electronic data processing of denial and approval files through monthly submission.
- Draft and maintain Corrective Action Plans and Overturn Letters for timely submission to Provider Delegation Department.
- Collect and review data from the monthly audit outcomes to be reported through Sanction Meetings and Delegation Oversight Committee.
- Communicate with Delegated IPA's and subcontractors for clarification or additional information.
- Effectively manage assigned projects and tasks related to Delegation Oversight activities.
- Provide support to maintain Delegation Oversight Policies and Procedures, including interim and annual updates.
- Update department regulatory reporting calendars including DHCS, DMHC, NCQA, and CMS.
- Prepare ad hoc reports, charts, graphs, and tracking tools as needed to support the Delegation Oversight Department.
- Provide operational support to the Delegation Oversight Department as needed.
- Effectively communicate and report assigned deliverables to Delegation Oversight Department including management.
- High School Diploma or GED required
- Minimum two (2) years of experience as a data entry specialist required
- Familiarity with California managed care programs such as CMC and Medi-Cal
- Strong understanding of ICD-10, CPT codes, and medical terminology
- Experience working in a managed care or healthcare regulatory environment
- Cultural sensitivity and the ability to work effectively in a multicultural community
Onsite: Monday & Friday: WFH: Tues, Wed, Thurs
INDH
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