Job Description
The UM Coordinator assists and supports the clinical team (UM Nurses/Medical Director) with administrative and non-clinical tasks related to processing Utilization Management prior authorization sand appeals.
JOB RESPONSIBILITIES
+ Monitor incoming faxes
+ Enter UM authorizations review requests in UM platform using ICD-10 and HCPCS codes
+ Verify eligibility and claim history in proprietary claims platform
+ Verify all necessary documentation has been submitted with authorization requests
+ Contact requesting providers to obtain medical records or other necessary documentation related to specific UM request
+ Generate correspondence and assist with faxing/mailing member and provider notifications
+ Complete verbal notifications
+ Document as required in authorization platform
+ Initiate appeal cases and forward to UM Nurses for completion
+ Meet internal and regulator deadlines for UM c...
JOB RESPONSIBILITIES
+ Monitor incoming faxes
+ Enter UM authorizations review requests in UM platform using ICD-10 and HCPCS codes
+ Verify eligibility and claim history in proprietary claims platform
+ Verify all necessary documentation has been submitted with authorization requests
+ Contact requesting providers to obtain medical records or other necessary documentation related to specific UM request
+ Generate correspondence and assist with faxing/mailing member and provider notifications
+ Complete verbal notifications
+ Document as required in authorization platform
+ Initiate appeal cases and forward to UM Nurses for completion
+ Meet internal and regulator deadlines for UM c...