UM Coordinator

Job Description

Job Description

POSITION SUMMARY

Reports to Clinical Operations Manager. The Utilization Management Coordinator is responsible for processing and assisting with 80-100 authorizations per day, reviewing authorizations for accuracy such as completeness which includes correct address, correct provider, all appropriate CPT codes, ICD-10 codes, and correct place of service / facility. Individuals must be able to execute effective communications verbally and in writing. Maintain patient confidentiality and promote departmental and organizational goals.

RESPONSIBILITIES-DUTIES

• Individuals will be available to assist Licensed Nursing staff with non-clinical tasks associated with the processing of prior authorizations but primarily assist other outpatient UM staff with daily tasks.
• If a member is not in the system, notifies eligibility by submitting member inquiry.
• Provides benefit and or guideline information to the authorization, Information is uploaded onto the authorization prior to passing to the clinical review UM Nurse, and / or Medical Director.
• Calls providers to obtain the supporting medical documentation needed for Prior Auth Nurse, and / or Medical Director to review.
• Educates providers as needed with the Authorization / Referral process under the direction on Admin Authorization Supervisor and Outpatient Prior Authorization Coordinator, II & III.
• Maintains confidentiality of all members and medical / clinical information.
• Performs as necessary to any departmental changes, workload and / or emergencies.
• Understands UM Policies / Procedures.
• Ensures the privacy and security of PHI(Protected Health Information)as outlined in AMM policies and procedures relating to HIPPA compliance.
• Performs other duties as directed by Admin Auth Supervisor and / or UM Director.

EDUCATION & EXPERIENCE REQUIREMENTS

AMM BENEFITS

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