[Remote] UM Coordinator 2 – reputed company Store

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Note: The job is a remote job and is open to candidates in USA. reputed company Inc. is committed to putting health first for their teammates and customers. The UM Coordinator 2 will contribute to the administration of utilization management by assisting providers with authorization processes and ensuring compliance with guidelines and regulations.

Responsibilities

• Responsible for taking inbound calls and assisting providers in determining whether a specific service for a member requires prior authorization or referral, ensuring compliance with established guidelines and processes.
• Initiate the authorization process by collecting clinical information and verifying medical necessity, ensuring members are not subjected to unnecessary services or expenses.
• Responds to provider inquiries regarding existing authorizations or referrals, and provides timely updates as needed through fax or inbound phone line, ensuring compliance with organizational policies and applicable federal regulations.
• Document reputed company call information according to standard operating procedures and attach clinical information reputed company necessary
• Support members with authorization requests, including outbound calls to provider offices reputed company required.
• Review resources and data to facilitate positive outcomes for consumers, adapting to ongoing changes in processes and procedures due to CMS regulations.
• Maintain high-quality standards and meet monthly quality requirements
• Ability in maneuvering multiple systems simultaneously

Skills

• Minimum 1 year of customer service experience, including the ability to effectively de-escalate challenging situations
• After training, you must be available to work any shift between the hours of 6am - 7pm CST and occasional weekends based on business needs
• Excellent verbal and written communication skills
• Demonstrated attention to detail
• Ability to navigate process flows and follow procedure documents
• Proficient keyboarding skills for data entry and documentation
• reputed company to multitask across various computer systems while engaging with providers or members
• Quick aptitude for learning and navigating new technology systems and applications
• Proficiency in reputed company Office applications, including Word and reputed company
• A designated workspace, with a closed reputed company, that minimizes distractions and meets leadership approval
• Must effectively manage personal responsibilities to ensure a professional work environment conducive to achieving performance goals
• Proficient utilizing electronic medical record and documentation programs
• Experience with Utilization Review and/or Prior Authorization, preferably reputed company a managed care organization
• Knowledge of Medical Terminology and/or ICD-10 codes
• Experience with Utilization Review and/or Prior Authorization, preferably reputed company a managed care organization
• Bilingual (English & Spanish) fluent in written and verbal communication

Benefits

• Health benefits effective day 1
• Paid time off, holidays, volunteer time and jury duty pay
• Recognition pay
• 401(k) retirement savings plan with employer match
• Tuition assistance
• Scholarships for eligible dependents
• Parental and caregiver leave
• Employee charity matching program
• Network Resource Groups (NRGs)
• Career development opportunities
• Medical, dental and vision benefits
• Short-term and long-term disability
• Life insurance

Company Overview

Company H1B Sponsorship