UM Coordinator

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

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