Coordinator - Utilization Management Outpatient - 4/10 Weekend Shift

Position Summary/Position

Under the general direction of the UM Outpatient Manager and Supervisor, the Outpatient UM Coordinator, is a high paced position that requires timely processing of authorization requests, verifying eligibility and obtaining additional information as requested by Medical Management or Utilization Management Nurses. This position requires that one be organized, ability to multitask with a working knowledge of ICD.9/10, CPT Coding and Medical Terminology. The Outpatient UM Coordinator will also ensure that provider calls are responded to in an accurate and timely manner while always maintaining highest level of customer service.

Major Functions (Duties and Responsibilities)

1. Responsible for monitoring the Right Fax Server. Ensuring all referrals are processed in a timely manner and ensuring compliance with appropriate turnaround timeframes.
2. Responsible for checking the referral form for completeness, obtaining missing demographic information as needed, and initial attempts at coding any uncoded referrals.
3. Responsible for meeting accuracy standards for appropriate authorizations of referrals at the UM Coordinator level.
4. Responsible for representing the Inland Empire Health Plan in a friendly and professional manner while answering the calls for the Utilization Management Department.
5. Communicate with providers in consultation with the Utilization Management Nurse, regarding authorizations, modifications, denials, and other matters pertinent to processing authorization requests or other UM related correspondence.
6. Assist Management or Utilization Management Nurses as requested.

Major Functions (Duties and Responsibilities) Cont

Supervisory Responsibilities

Experience Qualifications

Minimum of three (3) years of experience as a data entry specialist or coordinator.

Preferred Experience

Experience as a data entry specialist or coordinator preferably in an HMO or Managed Care setting.

Education Qualifications

High school diploma or GED required.

Preferred Education

Associate's degree or Bachelor's degree from an accredited institution preferred.

Professional Certification

Medical Assistant certificate preferred.

Professional Licenses

Drivers License Required

Knowledge Requirement

Requires knowledge of ICD-9/10 and CPT codes. Managed Care or physician office a must.

Skills Requirement

Skilled in computer applications, including word processing, database, and spreadsheets. Good customer service skills.

Abilities Requirement

Commitment to Team Culture

The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.

Working Conditions

While performing the duties of this job, team member is occasionally required to stand; walk; sit; use hands to finger, handle or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk or hear; and use taste or smell. The team member must occasionally lift or move up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus.

Position is eligible for telecommuting/remote work location upon completing the necessary steps and receiving HR approval. All IEHP positions approved for telecommute or hybrid work locations may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership.

Work Model Location

Physical Requirements