Utilization Management Coordinator

Job Summary

Supporting the Utilization Management Team, the full-time Coordinator, UM Intake (Fax Admin) will manage the efficient intake, review, and processing of documents while working remotely and adhering to a schedule of 9:30 am - 6 pm Pacific with rotating weekends and holidays.

Key responsibilities

• Prepare inbound faxes for processing, ensuring accurate document classification
• Review Service Level Agreement Grids to determine appropriate turnaround timeframes and document them accurately
• Monitor the failed fax dashboard to coordinate the re-sending of unsuccessful transmissions and respond to clinician inquiries in a shared email inbox

Required qualifications

• High school diploma or GED
• 1 - 3 years of experience in a population management or managed care/insurance setting
• Basic knowledge of medical records and ability to verify member details
• Familiarity with health insurance lines of business (Commercial, Medicare, Medicaid)
• Working knowledge of medical coding systems, including CPT/HCPCS codes