UM Coordinator
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Job Location:
Bakersfield, CA - USA
Monthly Salary:
Not Disclosed
Posted on:
30+ days ago
Vacancies:
1 Vacancy
Job Summary
Where Youll Work
Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options including medical dental and vision plans for the employee and their dependents Health Spending Account (HSA) Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.
Job Summary and Responsibilities
****This position is work from home within California.
In this role you will execute all aspects of the referral process and promote the quality and cost effectiveness of medical care through strict adherence to all Utilization Management (UM) Policies and procedures promptly efficiently and accurately. The UM Coordinator collaborates with clinical team members to evaluate the potential over and under-utilization of specialty services based on clinical protocols.
Essesntial functions include:
- Communicate effectively and interact with the utilization review nurse and health plans daily or as indicated regarding UM and referral authorization issues.
- Data entry via the core admin platform/software
- Process request that are approved denied or deferred and in accordance with utilization management policy and procedure.
- Responsible for Deferred authorization maintenance tracking and follow up.
- Responsible for the EIOD process including log maintenance; and member notifications
- Returns phone calls to members physicians and health plans and follows up with requests.
Job Requirements
Minimum Qualifications:
- 3 years working in a health care or other related business environment working in authorizations medical office and/or medical billing services
- High school diploma or GED
- Proficient in Google Workspace/Microsoft Office programs
- Knowledge of PPO/HMOs IPAs and Managed Care.
- General knowledge of EZCAP
Preferred Qualifications:
- Vocational school graduation in medical front office or medical billing and coding preferred
- Knowledge of Medicare processing guidelines preferred
Required Experience:
IC
Key Skills
- Corporate Risk Management
- Electronics
- Infection Control
- Bakery
- ELV
- Accident Investigation
About Company
Dignity Health provides compassionate, high-quality, affordable health care services throughout Arizona, California and Nevada. Schedule an appointment today!
