[Remote/WFM] Remote Coordinator for Utilization Management
Key Job Details:
- Start Date: Immediate openings available
- Position: Remote Coordinator
- Location: Remote
- Compensation: a competitive salary
- Company: Utilization Management
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Job Title: Utilization Management Coordinator - Remote Job Overview As a vital member of our clinical team, the Utilization Management (UM) Coordinator will provide essential support in handling administrative and non-clinical tasks related to the processing of UM prior authorizations and appeals. This position is designed for those who thrive in a dynamic and fast-paced environment, offering significant opportunities for professional growth while contributing to our mission of enhancing the quality of life for the communities we serve. Key Responsibilities  Monitor and manage incoming faxes  Input UM authorization review requests into our proprietary UM platform using ICD-10 and HCPCS codes  Verify eligibility and claims history within our claims system  Ensure comprehensive documentation accompanies all authorization requests  Communicate with requesting providers to gather necessary medical records or documentation  Prepare and disseminate correspondence, including member and provider notifications  Execute verbal notifications and maintain documentation in the authorization platform  Initiate appeal processes and collaborate with UM Nurses for completion  Adhere to internal and regulatory deadlines for UM processes  Handle inquiries from the call center and other internal and external sources  Perform additional tasks as assigned by the UM Director Required Skills  Exceptional organizational skills with the ability to adapt to rapid changes  Team-oriented mindset with a self-motivated and positive attitude  Proficient knowledge of ICD-10, HCPCS codes, and medical terminology  Strong computer skills, particularly in Word, Outlook, and relevant software applications  Effective written and verbal communication abilities  Capability to collect data, establish facts, and derive valid conclusions  Experience with DMEPOS is desirable  Familiarity with Medicare and Medicaid is advantageous Qualifications  Minimum of 1 year of experience in a UM Coordinator role within a managed care payer environment is preferred  Proven ability to prioritize and manage multiple tasks efficiently Career Growth Opportunities In your first six months, you will gain proficiency in verbal notifications, authorization systems such as Essette and Salesforce, and develop a thorough understanding of UM team expectations. Over the first year, you will deepen your knowledge of ICD-10 and HCPCS codes while meeting essential timelines. Company Culture And Values Established in 2005, our organization is a prominent network management company specializing in Orthotics, Prosthetics, and Durable Medical Equipment. We aim to transform access to in-home healthcare, positively impacting the communities we serve. Our culture emphasizes collaboration and teamwork, guided by our core values: One Team, Drive Results, Push the Boundaries, Value Others, and Build Community. We seek motivated and dedicated individuals eager to join our mission-driven team. Compensation And Benefits  Competitive hourly wage of $19  Comprehensive benefits package including Medical, Dental, Vision, Life Insurance, and Paid Time Off (PTO)  Retirement plan with company match  Paid Parental Leave and Sick Time  Company-sponsored events and health and wellness programs  Remote work flexibility available for eligible candidates. Employment Type: Full-Time Apply Job!Â
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