Utilization Management Coordinator
Pay Range: $20.24hr - $24.24hr
The Utilization Management Coordinator will provide administrative and operational support for utilization management activities, including authorization processing, benefit verification, claims inquiries, and coordination with members and providers. The role requires strong organizational skills, healthcare industry knowledge, and the ability to work effectively in a fast-paced managed care environment.
Requirement/Must Have:
- High School Diploma or equivalent.
- 3 years of experience in healthcare claims, healthcare service areas, or office support.
- Strong communication, organizational, and customer service skills.
- Knowledge of medical terminology and managed care concepts.
- Experience using Microsoft Office applications including Word, Excel, and PowerPoint.
- Ability to work independently and collaboratively within a multidisciplinary team.
- Strong attention to detail and decision-making skills.
Experience:
- Experience in healthcare or managed care environments preferred.
- Experience handling authorization requests and claims inquiries.
- Experience with case documentation and administrative coordination.
- Knowledge of CPT and ICD-10 coding preferred.
- Experience with web-based healthcare systems and applications.
Responsibilities:
- Perform administrative support activities related to members and providers including benefit verification, authorization management, claims inquiries, and case documentation.
- Review authorization requests for initial determination and triage requests for clinical review and resolution.
- Respond to telephone calls, messages, letters, and correspondence while assisting with issue resolution.
- Support departmental coordination activities and administrative functions.
- Assist with reporting, data tracking, information gathering, and dissemination processes.
- Support Continuity of Care processes and Peer to Peer review tracking activities.
- Maintain accurate records and documentation in accordance with department procedures.
Should Have:
- Knowledge of healthcare claims and utilization management processes.
- Understanding of standardized business processes related to medical support operations.
- Ability to prioritize workload and manage multiple tasks efficiently.
- Strong problem-solving and analytical skills.
- Professional communication and interpersonal skills.
Skills:
- Utilization management coordination.
- Authorization processing and management.
- Claims inquiry handling.
- Benefit verification.
- Medical terminology.
- CPT and ICD-10 coding knowledge.
- Data tracking and reporting.
- Customer service and communication.
- Microsoft Office Suite.
- Web-based healthcare applications.
Qualification And Education:
- High School Diploma required.
- Additional healthcare or managed care experience preferred.
- Relevant healthcare certifications or coding knowledge considered a plus.