Accountabilities
- Monitor incoming faxes
- Enter UM authorizations review requests using ICD-10 and HCPCS codes
- Verify eligibility and claim history in proprietary claims platform
- Ensure necessary documentation has been submitted with authorization requests
- Contact providers for medical records or documentation related to UM requests
- Generate correspondence and assist with member and provider notifications
- Complete verbal notifications
- Document as required in authorization platform
- Initiate appeal cases for UM Nurses to complete
- Meet internal and regulatory deadlines for UM cases
- Complete inquiries from call center and other sources
- Assist with other duties as assigned by UM Director
Requirements
- 1 year as a UM Coordinator in a managed care payer environment preferred
- Knowledge of ICD-10, HCPCS codes, and medical terminology required
- Strong time management and organizational skills
- Proficiency in Word, Outlook, and other software applications
- Ability to collect data and draw valid conclusions
- Effective written and oral communication skills
- Experience with DMEPOS desired
- Medicare/Medicaid experience a plus
Benefits
- Competitive compensation and annual bonus program
- 401(k) retirement program with company match
- Company-paid life insurance
- Company-paid short term disability coverage
- Medical, Vision, and Dental benefits
- Paid Time Off (PTO)
- Paid Parental Leave
- Sick Time
- Paid company holidays and floating holidays
- Quarterly company-sponsored events
- Health and wellness programs
- Career development opportunities
Why Apply Through Jobgether?
We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.
We appreciate your interest and wish you the best!
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