The UM Administration Coordinator 2 provides non-clinical support for the policies and procedures ensuring best and most appropriate treatment, care or services for members. Decisions are typically focus on interpretation of area/department policy and methods for completing assignments. Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing, and works under minimal direction. Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion.
Triage internal and external phone calls appropriately.
Communicate with providers to request clinical information and coordinate case dispute reviews.
Review and attach clinical information to authorizations.
Generate, proof, and send letters to members.
1 or more years administrative or technical support experience
Excellent verbal and written communication skills
Working knowledge of MS Office including Word, Excel, and Outlook in a Windows based environment and an ability to quickly learn new systems
Must have accessibility to high speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role); recommended speed is 10Mx1M
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Proficient utilizing electronic medical record and documentation programs
Proficient and/or experience with medical terminology and/or ICD-10 codes
Bachelor’s Degree in Business, Finance or a related field
Prior member service or customer service telephone experience desired
Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization
** Wednesday thru Sunday 9am-6pm EST; 40 hrs per week
Scheduled Weekly Hours