Job description
The UM Coordinator assists and supports the clinical team (UM Nurses/Medical Director) with administrative and non-clinical tasks related to processing Utilization Management prior authorizations and appeals.
Rate of Pay: $19.00/hour
JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIES
The UM Coordinator’s responsibilities include but are not limited to:
- Monitor incoming faxes
- Enter UM authorizations review requests in UM platform using ICD-10 and HCPCS codes
- Verify eligibility and claim history in proprietary claims platform
- Verify all necessary documentation has been submitted with authorization requests
- Contact requesting providers to obtain medical records or other necessary documentation related to specific UM request
- Generate correspondence and assist with faxing/mailing member and provider notifications
- Make outbound calls to providers and members for verbal notification
- Make outreach including faxes and calls for more documentation
- Document as required in authorization platform
- Initiate appeal cases and forward to UM Nurses for completion
- Meet internal and regulator deadlines for UM cases
- Complete tasks assigned by UM Nurses and document as required
- Complete inquiries received from call center and other internal & external sources
- Other duties as assigned by UM Leadership
- Ability to communicate with clients in a professional manner
- Strong organizational skills, ability to adapt quickly to change and desire to work in a fast-paced environment
- Team oriented and self-motivated with a positive attitude
EDUCATION: High school diploma required
EXPERIENCE:
- At least 1 year of experience as a UM Coordinator or similar administrative role within a health plan, managed care organization, or delegated UM entity.
- Familiarity with the UM process, including how authorization requests, appeals, and peer-to-peer reviews are routed and tracked within an authorization system.
- Comfortable working with clinical documentation (e.g. provider office notes, prescriptions, therapy assessments, sleep studies), with the ability to identify required components for submission.
- Experience working with ICD-10 and HCPCS codes, including verifying code accuracy, benefit limits, and documentation requirements.
- Able to use a fee schedule to confirm benefit coverage and determine allowable quantities or limits.
- Strong organizational and time management skills with the ability to prioritize and track multiple UM cases or requests simultaneously.
- Proficient computer skills required, including Microsoft Word, Outlook, and experience navigating healthcare software or authorization systems.
- Able to review documentation and cross-reference with policy or system requirements to confirm completeness, not for medical necessity.
- Strong written and verbal communication skills for professional interactions with providers and internal clinical staff.
- Experience with DMEPOS authorization workflows preferred.
- Familiarity with Medicare and/or Medicaid UM processes is preferred.
WHAT WILL YOU LEARN IN THE FIRST 6 MONTHS?
- How to work in authorization systems Essette and Salesforce
- Verbal notifications
- Incoming/outgoing faxing process
- Understanding the expectations and functions of the UM team
- Time Management
WHAT WILL YOU ACHIEVE IN THE FIRST 12 MONTHS?
- Expand knowledge of ICD-10 and HCPC codes
- Maintaining expected timelines
Benefits Offered
- Competitive compensation and annual bonus program
- 401(k) retirement program with company match
- Company-paid life insurance
- Company-paid short term disability coverage (location restrictions may apply)
- Medical, Vision, and Dental benefits
- Paid Time Off (PTO)
- Paid Parental Leave
- Sick Time
- Paid company holidays and floating holidays
- Quarterly company-sponsored events
- Health and wellness programs
- Career development opportunities
Remote Opportunities
We are actively seeking new colleagues in: Arizona, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Kentucky, Massachusetts, Michigan, North Carolina, New Jersey, New York, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, Vermont, and Washington.
Our Story
Founded in 2005, Integra Partners is a leading national durable medical equipment, prosthetic, and orthotic supplies (DMEPOS) network administrator. Our mission is to improve the quality of life for the communities we serve by reimagining access to in-home healthcare. We connect Payers, Providers, and Members through innovative technology and streamlined workflows affording Members access to top local Providers and culturally competent care. By focusing on transparency, accountability, and adaptability, we help deliver better health outcomes and more efficient management of complex healthcare benefits. Integra Partners is a wholly owned subsidiary of Point32Health.
With a location in Michigan plus a remote workforce across the United States, Integra has a culture focused on collaboration, teamwork, and our values: One Team, Drive Results, Push the Boundaries, Value Others, and Build Community. We’re looking for energetic, talented, and dedicated individuals to join our team. See what opportunities we have available; there may be a role for you to engage in a challenging yet rewarding career in healthcare. We look forward to learning more about you.
Integra Partners is an equal opportunity employer. We are committed to providing reasonable accommodations and will work with you to meet your needs. If you are a person with a disability and require assistance during the application process, please don’t hesitate to reach out. We celebrate our inclusive work environment and welcome members of all backgrounds and perspectives.
