Util Mgmt (UM) Coord (CHC)

UM CoordinatorUM Coordinator will assist in the process of CHC Providers obtaining authorization, ensuring accurate data entry in the Utilization Module, and assist with requested services/treatments that do not require clinical decision making. Handles entry of all notifications of admission, transfers, and assist with the data entry of requests for home health, and durable medical equipment. They will use analytical and professional skills to answer phone calls and screen documents for key information necessary for clinical staff and Medical Directors. This will assist them in making informed medical decisions regarding admissions, transfers, services, and transports. They will also support regulatory timelines and CHC guidelines. Assists in monitoring reports and refers to appropriate UM Nurse or Manager. Data entry of requests for authorization for admissions, notification of deliveries, sick newborns, and other services. Obtains all pertinent information and medical codes related to the admission, transfer, out of network provider, route of transport, type of service, type of durable medical equipment and other key information. Data entry and processing of fax and telephone requests to meet performance and quality standards while maintaining regulatory timeframes. Responds to calls from the provider hotline for referral/authorization initiation and questions. Answers in a timely and professional manner. Forwards calls to appropriate nursing or medical staff as required or needed. Forwards calls efficiently to other departments when appropriate. Responsible for ensuring that provider hotline calls are answered within established regulatory time standards to minimize hold time and avoid abandoned calls. Meets required call handling standards and quality reviews. Actively contributes to achievement of departmental goals, as identified in Department's annual business plan, including specific departmental process improvement plans and other duties as assigned.Qualifications: Education/Specialized Training/Licensure: High School or equivalent Some years of college, preferred Work Experience (Years and Area): Three (3) years of experience Referrals/Authorization. required. At least one (1) year insurance related experience in managed care environment or equivalent required. Experience in Medical Coding, preferred. Software Proficiencies: Microsoft Office (Word, Excel, Outlook)