UM Referral Coordinator - Bakersfield

Overview

Description

Location:

Bakersfield, CA 93307 (Onsite)

Classification:
Full-Time

This position is non-exempt and will be paid on an hourly basis.

Schedule:

Monday-Friday 8am-5pm

• Medical
• Dental
• Vision
• Paid Time Off (PTO)
• Floating Holiday
• Simple IRA Plan with a 3% Employer Contribution
• Employer Paid Life Insurance
• Employee Assistance Program

The initial pay range for this position upon commencement of employment is projected to fall between $20.96 and $26.19. However, the offered base pay may be subject to adjustments based on various individualized factors, such as the candidate's relevant knowledge, skills, and experience. We believe that exceptional talent deserves exceptional rewards. As a committed and forward-thinking organization, we offer competitive compensation packages designed to attract and retain top candidates like you.

Reporting to the Utilization Management leadership, the Referral UM Coordinator plays a pivotal role in furnishing essential clerical support and aiding the clinical team within the UM department on a day-to-day basis. This pivotal position assumes responsibility for efficiently handling a substantial volume of prior authorization requests. The UM Referral Coordinator ensures that all orders and referrals align with the health plan's benefits and promptly escalates any exceptions to the UM clinical team.

In adherence to UM guidelines and carve-out processes, certain authorizations are approved at a UM Coordinator level by the UM Referral Coordinator. This role also encompasses the critical task of validating eligibility, benefits, and contract status for requested providers. On a regular basis, the UM Referral Coordinator interacts with various stakeholders, including UM staff, Medical Directors, other healthcare providers, health plans, and relevant personnel both within and outside the organization.

The UM Referral Coordinator diligently and accurately processes medical authorizations, strictly adhering to company and departmental policies and procedures. This includes meticulous verification of all submitted information for accuracy. Furthermore, this position assumes the responsibility of independently managing assigned tasks and activities, following established policies and procedures with precision and expertise.

• Accurately processes medical authorizations according to company/department policies and procedures.
• General knowledge of CPT and ICD9/ICD
  10 and HCPCS codes as it relates to the processing of medical billing and/or authorizations.
• Familiar with medical terminology as it relates to IPA's, PPO's and HMO's
• Ability to interpret and communicate complex contract or benefit language.
• Strong problem-solving abilities. Ability to identify issues and problems within administrative processes and other relevant areas.
• Composes basic letters, faxes, & emails which are sent to various providers as it relates to authorizations.
• Works collaboratively with internal departments to obtain information or documentation required to accurately process authorizations.
• Verifies all information in EZCAP is correct and makes changes/ updates as necessary.
• Answers all authorization inquiries in a professional and positive manner ensuring that all information given is accurate.
• Conducts calls to providers, facilities, vendors for additional information on authorization requests, as needed.
• Place calls to members and providers regarding authorization outcome within the necessary notification timeframe.
• Monitors emails and/or faxes daily and appropriately distributes incoming faxed requests.
• Monitors the determination and notification Turn-Around Time frames (TAT) and managing daily workload according to TAT requirements.
• Troubleshoot calls from members, providers, health plans, hospitals, and other business affiliates to facilitate a seamless UM service.
• Handles UM Department's mailing distribution and assisting in mail room, which may require scanning and inputting data in accordance with department practice.
• Implements patient discharge plans delegated by Inpatient UM Nurse by coordinating with home care agencies, post-acute care facilities, durable medical equipment companies, transportation agencies and others as indicated.
• Attentive to detail, accurate, thorough, and persistent in following through to completion of all activities, demonstrating initiative for completing work assignments.
• Excellent communication skills; able to read, write, and speak articulately, using established channels of communication and reporting relationships within the organization.
• Ability to communicate effectively with all levels of internal/external staff, management, members, physicians/physician office staff.
• Knowledge of generally accepted professional office procedures and processes. Universal Healthcare MSO, LLC
• Ability to use the following general office equipment correctly and safely: desktop computer for data entry and typing, copy machine, scanner,…