Alignment Health is seeking an organized, detail-oriented and customer service oriented inpatient utilization management (UM) coordinator to join the 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.
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 (respond to various workloads by assigning task priorities according to department policies, standards and needs).
Maintain confidentiality of information among health care professionals.
Required Skills and Experience:
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
Medical assistant experience preferred
High school diploma or general education degree (GED); with one to three months related experience and/or training; or equivalent combination of education and experience.
Medical Terminology Certificate preferred.
Knowledge of medical terminology
Knowledge of ICD10 and CPT codes
Knowledge of Medicare, HMO, MMO, managed care plans
Knowledge working in Access Express / Portal, Epic preferred.
Computer proficient
Proficient in Microsoft Office (Outlook, Excel, Word)
Able to type minimum 55 words-per-minute (WPM).
Organized and detail oriented.
File systematically.
Good interpersonal skills.
Strong written, verbal, and telephonic communication skills
Able to read, write, and speak English fluently.
Language Skills: Able to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. Able to write routine reports and correspondence. Communicate effectively using good customer relations skills.
Mathematical Skills: Able to add and subtract two-digit numbers and to multiply and divide with 10's and 100's. Able to perform these operations using units of American money and weight measurement, volume, and distance.
Reasoning Skills: Able to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Able to deal with problems involving a few concrete variables in standardized situations.
