Description:
Alignment Health is seeking an organized, detail-oriented and customer service oriented inpatient utilization management (UM) coordinator to join the remote UM team. As an inpatient UM coordinator, you will assist with managing census and admissions, retrieve medical records, and discharge planning while working with the case management (CM) supervisor, manager, and director of healthcare services.
If you are hungry to learn and grow, want to be part of a growing organization, and make a positive impact in the lives of seniors – we’re looking for you!
Schedule: Monday - Friday, 8am - 5pm Pacific Time (Required)
GENERAL DUTIES / RESPONSIBILITIES:
- Assist team with daily census by entering face sheets for hospitals and skilled nursing facilities (SNF).
- Obtain medical records from hospitals and SNF’s.
- Attach medical records to authorizations.
- Enter referral requests / authorizations in system using ICD 10 and CPT coding.
- Monitor fax folders.
- Complete and document tasks as assigned by nurse.
- Maintain documentation on facilities contacted.
- Assist with maintaining and updating member’s records.
- Assist with mailing or faxing correspondence to facilities, related to, as needed.
- Request medical records from facilities, etc., related to members activities, as needed.
- Attend case management presentations and participates, as appropriate.
- Recognize work-related problems and contributes to solutions.
- Meet specific deadlines and respond to various workloads by assigning task priorities according to department policies, standards and needs.
- Maintain confidentiality of information between and among health care professionals.
- Be a positive team player.
Experience:
Job Requirements:
Required:
- Inpatient concurrent review experience
- Experience with census and admission management
- Experience in discharge planning
- Experience entering referrals and prior authorizations.
- Experience with Medicare Advantage
- Experience with hospital and / or facilities backend admissions
- Knowledge of medical terminology
- Knowledge of ICD10 and CPT codes
- Knowledge of Medicare, HMO, MMO, managed care plans
- Computer proficient
- Preferred:
- Medical assistant experience preferred
- Knowledge working in Access Express / Portal, Epic preferred.
Education:
Required:
- High school diploma or general education degree (GED) or (4) years' additional experience in lieu of education.