Utilization Management Coordinator I

Job Description This position is responsible for providing support to the Medical Management department to ensure timeliness of outpatient or inpatient referral/authorization processing per state and federal guidelines.

This position performs trouble-shooting when problems situations arise and coordinates with leadership.

Qualifications High School Diploma or equivalent required.

MA or Medical Billing Certificate preferred.

Minimum 1 year of experience working in a medical billing environment (IPA or HMO preferred), with pre-authorizations and reimbursement regulations pertaining to Medi-Cal, CCS and other government programs required.

Prior experience working in a clinic/health care specialty call center.

Prefer experience in utilization management processing authorization referrals.

Responsibilities Input data into the Medical Management system to ensure timeliness of referral/authorization processing.

Verifies member benefits and eligibility upon receipt of the treatment authorization request.

Utilizes authorization matrix, ancillary rosters, DOFR, and/or delegation agreements to drive decision-making.

Coordinates with referral nurse and/or Medical Director for timely referral processing.

Ensure timely provider and member oral and written notification of referral decisions.

Ensures proper notification of patient facility admissions with PCP and NOMNC when applicable.

Coordinate board certified referrals with partner vendors.

Coordinates and assists with patient appointments as needed and notify patient of authorization status.

Performs trouble-shooting when problems situations arise and coordinates with leadership.

Prepares denial letters for review by Medical Director or Nurse Reviewer(s) and distributes letters to appropriate recipients.

Demonstrates excellent communications skills and interpersonal relationships.

Collaborates and facilitates interdisciplinary team communications.

Perform additional duties as assigned.

Process referrals within the dept.

targets based on workflows and technology.

Meets inter-rater minimum standards for core responsibilities.

Benefits AltaMed offers a comprehensive benefits program that recognizes the needs of our diverse employees by supporting their health, security and professional growth.

Wellness Medical/Dental/Vision Plans Voluntary Short-term Disability Plan Long-term Disability Plan Paid Time Off Health Care and Dependent Care Reimbursement Accounts (FSA) Employee Assistance Program (EAP) Planning Ahead 403 (b) Retirement Plan Life Insurance (Basic & Voluntary) Accidental Death & Dismemberment (Basic & Voluntary) Career Growth and Development Tuition Reimbursement Continuing Education Programs Other Benefits Employee Reward & Recognition Programs Corporate Employee Discount Programs Wellness Programs by Jobble