Utilization Management Coordinator

Job Summary

Assisting the clinical team with administrative tasks, the full-time remote Utilization Management Coordinator will manage incoming faxes, enter authorization requests, and verify documentation for prior authorizations and appeals.

Key responsibilities

• Monitor incoming faxes and enter UM authorization review requests using ICD-10 and HCPCS codes
• Verify eligibility and documentation for authorization requests and initiate appeal cases
• Document actions in the authorization platform and assist with inquiries from internal and external sources

Required qualifications

• 1 year of experience as a UM Coordinator in a managed care payer environment preferred
• Knowledge of ICD-10, HCPCS codes, and medical terminology required
• Strong computer skills with proficiency in Word, Outlook, and other software applications
• Ability to prioritize multiple tasks effectively using time management and organizational skills
• Experience with DMEPOS and Medicare/Medicaid is a plus