Utilization Management Coordinator

This is a fully remote position, open to applicants in California.

📋 Description

• Manage all incoming authorizations received through the Tapestry Link portal or OnBase.

• Confirm eligibility or benefits and input data into Tapestry prior to processing when necessary.

• Handle authorizations within the designated Turn Around Times in accordance with ICE regulations.

• Act as the main point of contact for both internal and external customers seeking authorization information or support.

• Evaluate authorization requests based on established review-level classifications.

• Draft denial letters under the supervision of professional staff.

• Offer precise technical information to provider offices and internal stakeholders.

• Reach out to provider offices via phone for any missing clinical documentation and record the requested information in Tapestry.

• Engage in cross-training with UM Coordinators to understand each process and ensure adequate coverage.

• Safeguard the confidentiality of health records and member data.

⛳️ Requirements

• High school diploma.

• Two years of prior experience in Utilization Management (UM), medical records, medical billing, or a medical office setting.

• 2-3 years of experience with Microsoft Office programs is required.

• A certificate or equivalent experience in medical terminology, CPT, HCPCS, and ICD coding is required.

• Must uphold strict confidentiality regarding health records and member information.

• Must adhere to HIPAA regulations.

• External candidates must successfully pass a background check and drug screening.

🏝️ Benefits

• Comprehensive medical, vision, and dental insurance.

• 401k savings plan with company matching.

• Flexible time off policy.

• 9 Paid Holidays.

• Eligibility for an annual bonus program.