UM Coordinator, Pre-Service

🕒 Julho 23

🏄 California – Remoto

🏄 California – Remote

💵 $41.472 - $62.208 / ano

⏰ Tempo Integral

🟢 Júnior

🚫👨‍🎓 Sem graduação necessária

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Alignment Health

SiteLinkedInTodas as Vagas

501 - 1000 funcionários

Fundada em 2013

⚕️ Seguro de Saúde

🛡️ Seguros

🏥 Saúde

💰 $135.000.000 Series C em 2020-03

Healthcare Insurance • Insurance • Healthcare

Alignment Health está comprometida em fornecer cuidados abrangentes para membros do Medicare, enfatizando as necessidades dos idosos, dos cronicamente doentes e daqueles que são frágeis. Com a missão de transformar a saúde dos idosos, a Alignment Health utiliza um modelo de atenção personalizado e tecnologia avançada para oferecer serviços de saúde de alta qualidade e baixo custo. Sua equipe de atendimento de concierge 24 horas por dia, 7 dias por semana, colabora com provedores locais confiáveis para garantir que cada membro receba um atendimento personalizado, refletindo o compromisso da empresa em tratar todos os membros como membros valiosos da família.

Descrição

• Monitor fax folders. • Verify eligibility and / or benefit coverage for requested services. • Enter pre-service requests/authorizations in system using ICD 10 and CPT coding. • Verify all necessary documentation has been submitted for pre-service request. • Contact and request medical records, orders, and/or necessary documentation from requesting provider in order to process related pre-service requests/authorizations when necessary. • Document the referral process and any pertinent determination factors within the referral system. • Process pre-service request for medical services such as DME, office visits and radiology using approval criteria. • Assist with mailing or faxing correspondence to PCP’s, Specialists, related to requests / authorizations as needed. • Contact members and maintain documentation of call for Expedited requests. • Complete tasks assigned by nurse and document accordingly. • Answer queue calls relating to UM review and pre-service status. • Recognize work-related problems and contributes to solutions. • Meet specific deadlines and respond to various workloads by assigning task priorities according to department policies, standards and needs. • Maintain confidentiality of information between and among health care professionals. • Be a positive team player.

🎯 Requisitos

• Minimum (1) year experience in a medical setting working with IPAs, entering referrals / prior authorizations preferred. • Knowledge of ICD10, CPT codes, Medicare Managed Care Plans, medical terminology (certificate preferred) and referral system (Access Express/Portal/N-coder). • High school diploma or general education degree (GED) and / or training: or equivalent combination of education and experience required. • Computer proficient • Able to type minimum 50 words per minute (WPM) • Experience with Microsoft Office (Word, Excel, Outlook) • Experience with the application of UM criteria (i.e., CMS National and Local Coverage Determinations, etc.) • Bilingual English / Spanish preferred.

🏖️ Benefícios

• Health insurance • 401(k) matching • Paid time off • Flexible work arrangements