Healthcare Utilization Management Coordinator l needed for a contract opportunity with Yoh’s client located in San Leandro, CA!
Top Skills Should You Possess:
- Previous experience with medical records and medical billing in a medical office setting
- Utilization Management or HMO/IPA experience strongly preferred
What You’ll Be Doing:
- Research medical utilization management requests using a variety of resources including the Health Plans’ evidence of coverage, policies and procedures, industry healthcare resources and State eligibility verification systems
- Refer cases to UM Nurses, Case Managers, including the Medical Director, for clinical review, potential denial or modification
- Provide administrative and clerical support for utilization management and case management activities
- Answer questions and resolves issues promptly from members and providers pertaining to referrals, benefit verification, eligibility verifications function and authorization status and modification request
- Ensure the privacy and security of PHI (Protected Health Information) as outlined in the policies and procedures relating to HIPAA compliance
- Make telephone calls to members and providers according to utilization management and case management protocols
- Communicate regularly via phone with health plan UM staff, providers, inpatient staff, and select government entities such as California Children’s Services
- Enter prior authorization required data in EZ-CAP or a selected database program with accuracy in a timely manner
What You Need to Bring to the Table:
- High school diploma or General Education Degree (GED) required
- Current Medical Assistant Certification or California Pharmacy Technician License or equivalent experience in a health care field with familiarity with medical terminology and concepts, required
- Minimum of one to two years previous health care experience with medical records, medical billing, or medical office experience
- Minimum of one year of experience with State and Federal insurance programs
- Experience in an HMO/IPA or experience in a managed care setting a plus
- Excellent written and verbal communication skills, to allow for effective communication at all levels
- Proficient in CPT/HCPCS and ICD-10 codes
- Organized and self-managed person with the desire to learn and the ability to work well with others
- Knowledge and application of English grammar including composition, editing and proofreading skills
- Ability to handle detailed work, work with varying types of data and maintain confidentiality
- Strong organization, time management and multi-tasking abilities
What’s In It For You?
We welcome you to be a part of the largest global staffing companies to meet your career aspirations. Yoh’s network of client companies has been employing professionals like you for over 65 years in the U.S., UK and Canada. Join Yoh’s extensive talent community that will provide you with access to Yoh’s vast network of opportunities.
- Medical, Dental & Vision Benefits
- 401K Retirement Saving Plan
- Life & Disability Insurance
- Direct Deposit & weekly EPayroll
- Employee Discount Programs
- Referral Bonus Programs
What are you waiting for? Apply Now!
Recruiter: Annie Gill
Yoh makes finding and applying for jobs simple. Partner with Yoh to find the right opportunities across multiple industries in the US and UK. Find out more!
Yoh, a Day & Zimmermann company, is an Equal Opportunity Employer, M/F/D/V. Click hereto contact us if you are an individual with a disability and require accommodation in the application process.
Yoh Staffing Solutions