Verda Healthcare, Inc. has a contract with the Center of Medicaid and Medicare Services (CMS) and Texas Department of Insurance for a Medicare Advantage Prescription Drug (MAPD) plan for 2024. We are looking for a UM/QI Coordinator to join our growing company with many internal opportunities.
Are you ready to join a company that is changing the face of health care across the nation? Verda Healthcare, Inc. is looking for people like you who value excellence, integrity, caring and innovation. As an employee, you’ll join a team dedicated to improving the lives of our Medicare members. Our vision incorporates value-based health care that works. We value diversity.
Align your career goals with Verda Healthcare, Inc. and we will support you all the way.
Position Overview
Verda Healthcare is seeking an organized, detail-oriented inpatient utilization management (UM), Case Management (CM), and Quality Management (QM) coordinator to join the UM/QM team. As a coordinator, you will assist with managing census and admissions, UM outpatient request, collection of analytical data, retrieve medical records, and discharge planning while working with the case management (CM) supervisor, manager, and director of healthcare services.
Essential Functions:
- Support the UM/CM/QI Nurses to process authorization requests, discharge, transition of care, member resources, and analytical data retrieval and collection.
- Make calls to contracted providers as needed to support UM/CM/QI.
- Process all incoming fax/emails/provider portal submission request for services the same day.
- Process provider and member letters (Letter of Agreements, Approvals, Denials etc.)
Responsibilities:
- Triage & Assign cases amongst the team on a rotating basis.
- Provide administrative support to UM, CM, and QI departments.
- Respond to providers/vendors regarding preauthorization requests, and status inquiries.
- Respond to all inpatient notifications (NOA) from providers.
- Attach medical records to authorizations.
- Enter referral requests / authorizations in system using ICD 10 and CPT coding.
- Complete and document tasks as assigned by nurse.
- Maintain documentation on facilities contacted.
- Assist with mailing or faxing correspondence to facilities.
- Request medical records from facilities, etc., related to members’ inpatient admission as needed.
- Assist with the retrieval/collection, and analysis of analytical data.
- Assist with maintaining and updating member’s records.
- Meet specific deadlines (respond to various workloads by assigning task priorities according to department policies, standards, and needs).
- Assist UM Nurses, CM, QM, Medical Directors and other Departments as needed.
Minimum Qualifications
- One or more years of administrative support, healthcare and/or telephonic customer service experience.
- Good verbal and written communication skills.
- Working knowledge of Microsoft Word, Excel, and Outlook.
- Knowledge of Medicare, HMO, MMO, managed care plans.
- Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization.
Professional Competencies
- 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.