UM Coordinator, Pre-Service (Remote | Pacific Time Schedule)

General Duties / Responsibilities

• Monitor fax folders.
• Verify eligibility and / or benefit coverage for requested services.
• Enter pre-service requests/authorizations in system using ICD 10 and CPT coding.
• Verify all necessary documentation has been submitted for pre-service request.
• Contact and request medical records, orders, and/or necessary documentation from requesting provider in order to process related pre-service requests/authorizations when necessary.
• Document the referral process and any pertinent determination factors within the referral system.
• Process pre-service request for medical services such as DME, office visits and radiology using approval criteria.
• Aid in mailing or faxing correspondence to PCP’s, Specialists, related to requests / authorizations as needed.
• Contact members and maintain documentation of call for Expedited requests.
• Complete tasks assigned by nurse and document accordingly.
• Answer queue calls relating to UM review and pre-service status.
• Recognize work-related problems and contribute to solutions.
• Meet specific deadlines and respond to various workloads by assigning task priorities according to department policies, standards and needs.
• Maintain confidentiality of information between and among health care professionals.
• Be a positive team player.

Job Requirements

• Minimum (1) year experience in a medical setting working with IPAs, entering referrals / prior authorizations preferred.
• Knowledge of ICD10, CPT codes, Medicare Managed Care Plans, medical terminology (certificate preferred) and referral system (Access Express/Portal/N-coder).
• High school diploma or general education degree (GED) and / or training: or equivalent combination of education and experience required.
• Computer proficient.
• Able to type minimum 50 words per minute (WPM).
• Experience with Microsoft Office (Word, Excel, Outlook).
• Experience with the application of UM criteria (i.e., CMS National and Local Coverage Determinations, etc.).
• Bilingual English / Spanish preferred.

Preferred

• Medical assistant experience preferred.
• Knowledge working in Access Express / Portal, Epic preferred.

Education

• Required: High school diploma or general education degree (GED) or (4) years' additional experience in lieu of education.
• PREFERRED: Medical Terminology Certificate preferred.

Training

• Required:
• Preferred:

Specialized Skills

• Proficient in Microsoft Office (Outlook, Excel, Word).
• Able to type minimum 35 words-per-minute (WPM).
• Organized and detail oriented.
• File systematically.
• Good interpersonal skills.
• Strong written, verbal, and telephonic communication skills.
• Able to read, write, and speak English fluently.

Work Environment

• The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Essential Physical Functions

• While performing the duties of this job, the employee is regularly required to talk or hear.
• The employee frequently lifts and / or moves up to 10 pounds.
• Specific vision abilities required by this job include close vision and the ability to adjust focus.

Pay Range

$41,472.00 - $62,208.00

Disclaimer

Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email careers@ahcusa.com.