UM Coordinator, Pre-Service

🔥 15 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $41.5k - $62.2k / year

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

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Alignment Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2013

⚕️ Healthcare Insurance

💰 $135M Series C on 2020-03

Healthcare Insurance • Insurance • Healthcare

Alignment Health is dedicated to providing comprehensive care for Medicare members, emphasizing the needs of seniors, the chronically ill, and those who are frail. With a mission to transform senior healthcare, Alignment Health leverages a tailored care model and advanced technology to deliver high-quality, low-cost healthcare services. Their 24/7 concierge care team collaborates with trusted local providers to ensure that every member receives personalized care, reflecting the company's commitment to treating all members as valued family members.

📋 Description

• 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.

🎯 Requirements

• 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.

🏖️ Benefits

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