Job Vacancy Utilization Management Coordinator II AltaMed



Job title: Utilization Management Coordinator II

Company: AltaMed

Job description: 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; taking independent action to resolve complex issues.
  • Prepares denial letters for review by Medical Director or Nurse Reviewer(s) and distributes letters to appropriate recipients.
  • Performs coordination for out-of-network cases and facilitates letters of agreement (LOA) processing in collaboration with Medical Directors and Leadership.
  • Performs coordination of benefits.
  • Demonstrates excellent communications skills and interpersonal relationships.
  • Collaborates and facilitates interdisciplinary team communications.
  • Perform additional duties as assigned.
  • Process referrals and/ or calls within the dept. targets based on workflows and technology.
  • Meets inter-rater minimum standards for core responsibilities.
  • If assigned to Provider Phone Queues, Collaborates with Customer Service Representatives to provide information regarding referral/authorization processing.
  • Appropriately tracks incoming call types and pertinent details of calls.

Qualifications

  • High School Diploma or equivalent required.
  • MA or Medical Billing Certificate preferred.
  • Minimum 2 years 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 in utilization management processing authorization referrals also required.
  • Prefer prior Lead position experience.

Expected salary:

Location: Montebello, CA

Job date: Sat, 16 Jul 2022 04:34:02 GMT

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