Utilization Management Coordinator

Job Summary

Supporting the clinical team, the full-time remote Utilization Management Coordinator will assist with administrative tasks related to processing prior authorizations and appeals, including monitoring incoming faxes and verifying documentation.

Key responsibilities

• Monitor incoming faxes and enter UM authorization review requests using ICD-10 and HCPCS codes
• Verify eligibility and claim history while ensuring all necessary documentation is submitted with authorization requests
• Initiate appeal cases 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 using time management and organizational skills
• Experience with DMEPOS and Medicare/Medicaid is a plus