What are the responsibilities and job description for the Remote Coordinator for Utilization Management position at Get It - Finance?
Job Title: Utilization Management (UM) Coordinator - Remote
Position Overview
Join our dedicated team as a Utilization Management Coordinator, where you will be an integral part of our clinical operations, providing essential support through administrative and non-clinical tasks related to processing Utilization Management prior authorizations and appeals. This role is perfectly suited for a highly organized and adaptable individual who thrives in a dynamic environment.
Key Responsibilities
This role offers a pathway for professional development within the Utilization Management team, with opportunities to enhance your knowledge in healthcare administration and clinical processes. Your contributions will be valued and can lead to career advancement in a thriving sector.
Company Culture And Values
Founded in 2005, we are a prominent network management organization specializing in Orthotics, Prosthetics, and Durable Medical Equipment. Our mission is to transform access to in-home healthcare, thereby improving the quality of life for the communities we serve. With a remote workforce and locations throughout the United States, we cultivate a culture of collaboration, teamwork, and inclusion, seeking enthusiastic, talented, and dedicated individuals to join our ranks.
Compensation And Benefits
We welcome applicants from: Arizona, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Kentucky, Massachusetts, Michigan, North Carolina, New Jersey, New York, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, Vermont, and Washington.
Equal Opportunity Employer
We are committed to creating an inclusive work environment and providing reasonable accommodations to individuals with disabilities. If you require assistance during the application process, please reach out. We celebrate diversity and welcome candidates from all backgrounds and perspectives.
Employment Type: Full-Time
Position Overview
Join our dedicated team as a Utilization Management Coordinator, where you will be an integral part of our clinical operations, providing essential support through administrative and non-clinical tasks related to processing Utilization Management prior authorizations and appeals. This role is perfectly suited for a highly organized and adaptable individual who thrives in a dynamic environment.
Key Responsibilities
- Oversee incoming faxes and accurately input UM authorization review requests into the UM platform utilizing ICD-10 and HCPCS codes.
- Validate eligibility and claims history in our proprietary system.
- Ensure that all required documentation accompanies authorization requests.
- Communicate with requesting providers to gather medical records or other necessary information pertaining to specific UM requests.
- Generate correspondence and assist with notifications to members and providers.
- Complete verbal notifications and document properly in the authorization system.
- Initiate appeal cases and forward to UM Nurses for processing.
- Adhere to internal and regulatory timelines for UM cases.
- Support UM Nurses with assigned tasks, documenting actions as necessary.
- Address inquiries from the call center and other internal and external stakeholders.
- Perform additional duties as directed by the UM Director.
- Proficiency in ICD-10 and HCPCS coding, along with a solid understanding of medical terminology.
- Exceptional organizational and time management capabilities.
- Strong computer literacy, particularly in Word, Outlook, and related applications.
- Effective written and verbal communication skills.
- Ability to gather data, assess facts, and formulate valid conclusions.
- Attention to detail and capability to manage multiple priorities.
- Experience with DMEPOS is preferred.
- Familiarity with Medicare/Medicaid processes is advantageous.
- A minimum of 1 year of experience as a UM Coordinator in a managed care payer environment is preferred.
- High School Diploma or equivalent; relevant certifications in healthcare administration are a plus.
This role offers a pathway for professional development within the Utilization Management team, with opportunities to enhance your knowledge in healthcare administration and clinical processes. Your contributions will be valued and can lead to career advancement in a thriving sector.
Company Culture And Values
Founded in 2005, we are a prominent network management organization specializing in Orthotics, Prosthetics, and Durable Medical Equipment. Our mission is to transform access to in-home healthcare, thereby improving the quality of life for the communities we serve. With a remote workforce and locations throughout the United States, we cultivate a culture of collaboration, teamwork, and inclusion, seeking enthusiastic, talented, and dedicated individuals to join our ranks.
Compensation And Benefits
- Competitive salary and an annual bonus program.
- 401(k) retirement plan with employer matching.
- Company-paid life insurance and short-term disability coverage (location restrictions may apply).
- Comprehensive Medical, Vision, and Dental benefits.
- Paid Time Off (PTO), Paid Parental Leave, and Sick Time.
- Paid company holidays and floating holidays.
- Quarterly company-sponsored events and health/wellness programs.
- Opportunities for career development and remote work options.
We welcome applicants from: Arizona, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Kentucky, Massachusetts, Michigan, North Carolina, New Jersey, New York, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, Vermont, and Washington.
Equal Opportunity Employer
We are committed to creating an inclusive work environment and providing reasonable accommodations to individuals with disabilities. If you require assistance during the application process, please reach out. We celebrate diversity and welcome candidates from all backgrounds and perspectives.
Employment Type: Full-Time
