Alignment Healthcare
posted 6 days ago
Full-time - Entry Level
Remote
1,001-5,000 employees
Professional, Scientific, and Technical Services
About the position
The Remote Utilization Management (UM) Coordinator at Alignment Health is a long-term temporary role focused on supporting the clinical team with administrative tasks related to processing clinical referrals. This position is essential for ensuring efficient utilization management processes and enhancing the overall experience for seniors receiving care. The role involves monitoring requests, verifying eligibility, and maintaining documentation while working within a fully remote environment.
Responsibilities
- Monitor fax folders
- Verify eligibility and/or benefit coverage for requested services
- Enter pre-service requests/authorizations in the system using ICD 10 and CPT coding
- Verify all necessary documentation has been submitted for pre-service requests
- Contact and request medical records, orders, and/or necessary documentation from requesting providers
- Accurately document the referral process and any pertinent determination factors within the referral system
- Process pre-service requests for medical services such as durable medical equipment (DME), office visits, and radiology using approval criteria
- Assist with mailing or faxing correspondence to PCPs and specialists related to requests/authorizations
- Contact members and maintain documentation of calls for expedited requests
- Comply with tasks assigned by the nurse and document accordingly
- Answer queue calls relating to UM review and pre-service status
- Recognize work-related problems and contribute to solutions
- Meet specific deadlines by assigning task priorities according to department policies, standards, and needs
- Maintain confidentiality of information between and among health care professionals
Requirements
- Minimum 1-year experience in a medical setting working with IPAs, entering referrals/prior authorizations preferred
- Knowledge of ICD10, CPT codes, Managed Care Plans, medical terminology (certificate preferred) and referral system (Access Express/Portal/N-coder) required
- High School Diploma or General Education Degree (GED) and/or training or equivalent combination of education and experience required
- Knowledge of Medicare Managed Care Plans
- Computer proficient
- Able to type a minimum of 50 words per minute (WPM)
- Experience with Microsoft Word, Excel, and Outlook
- Experience with the application of UM criteria (CMS National and Local Coverage Determinations, etc.)
- Bilingual English/Spanish preferred
- Positive, team player
Nice-to-haves
- Bilingual English/Spanish preferred
Benefits
- Medical benefits
- Flexible remote work environment
