UM Coordinator - Hybrid

Description

• Put Patients First
• Empower Entrepreneurial Provider and Care Teams
• Operate with Integrity & Excellence
• Be Innovative
• Work As One Team

What You'll Do

• Comply with UM policies and procedures. Annual review of selected UM policies.
• Read and understand NMM UM Customer Service Policy and Procedures
• Process Routine & Urgent treatment authorization requests according to the NMM Policy & Procedure Manual based on UM Level 1 review process.
• Assist with attaching incoming notes to appropriate authorizations
• Move referrals coming back from eligibility and or benefits to the correct queue for review
• Accurately review, screen and process daily assigned UM referrals (avg 150-250) in accordance with IPA and health plan TAT guidelines
• Responsible for verification to include but not limited to: benefit matrix through DOFR, eligibility, provider status (contracted/non-contracted), carved out and others.
• Contact providers office as needed for clarification, notes or redirections
• Verify that facilities are contracted and or a CMS approved facility when required.
• Attend to provider and interdepartmental calls in accordance with exceptional customer service
• Reports to UM Lead 3 on activities or problems occurring throughout the day.
• Maintains strictest confidentiality at all times.
• Maintain good relationships with health plans and medical directors and external contacts.
• Team skills, assist others as needed in order to comply with TAT.
• Other duties as assigned 

Qualifications

• High School Graduate, Bachelor's in Healthcare Administration is a plus 
• A minimum of two years experienced in managed care environment to include but not limited to an IPA or MSO preferred
• Knowledge of medical terminology, RVS, CPT, HPCS, ICD-9 codes
• Proficient with Microsoft applications, EZCAP preferred 
• Good organizational skills, verbal and written communication skills
• Ability to multitask and problem solve in a fast pace work environment
• Punctuality and detail-oriented 
• Ability to follow directions and perform work independently according to department standards
• Must be a strong team player and have excellent attendance record

Environmental Job Requirements and Working Conditions

• This is a hybrid position. The position will be fully in-office for 3 month probationary period. After successful completion of probationary period, position will transition to 2 days in-office and 3 days at home. The position is located at 1600 Corporate Center Dr, Monterey Park, CA 91754. 
• This position will typically work Monday - Friday from 8:30 am to 5:00 pm. There is required overtime in this position. We also require weekend and holiday coverage if there is business need. 
• The national target pay range for this role is $21.00 - $24.00 per hour. Actual compensation will be based on geographic location (current or future), experience, and other job-related factors.