Utilization Management Intake Coordinator

COMPANY OVERVIEW:

HealthAxis is a prominent provider of core administrative processing system (CAPS) technology, business process as a service (BPaaS), and business process outsourcing (BPO) capabilities to healthcare payers, risk-bearing providers, and third-party administrators. We are transforming the way healthcare is administered by providing innovative technology and services that uniquely solve critical healthcare payer challenges negatively impacting member and provider experiences.

We live and work with purpose, care about others, act with integrity, communicate with transparency, and don’t take ourselves too seriously.

We're not just about business – we're about people. Our commitment to a people-first approach shapes everything we do, from collaborating as a team to serving our valued clients. We believe that creating a vibrant and human-centric environment can inspire engagement, empower our team members, and ignite a sense of purpose in all that we accomplish.

APPLICATION INSTRUCTIONS:

We're moving quickly to fill these roles, so we appreciate your attention to detail during the application process! To help ensure a smooth and efficient review process, please complete all sections of the application form--incomplete applications may not be considered.

PURPOSE AND SCOPE:

The UM Coordinator is responsible for processing authorization requests for medical services from physicians and hospitals (providers) in an efficient, accurate and customer-focused manner.

PRINCIPAL RESPONSIBILITIES AND DUTIES:

• Effectively handles incoming authorization request intake process.

• Follows appropriate procedures for checking member eligibility, authorization history and provider network participation status.

• Based on the information provided by the provider and gathered from computer systems, determines the appropriate handling of each inpatient or outpatient request.

• Utilizing accepted protocol, determines authorization requirements based on the type of service requested, the location of the service, and the provider specifics.

• Inputs review data into systems.

• Based on authorization rules and urgency, either approves the authorization request, or sends to nurse for review.

• Communicates authorization specifics to providers either verbally through phone calls or written through fax.

• Interprets a variety of instructions furnished in written and oral forms.

• Assists in preparing and submitting projects, reports or assignments as needed to meet department initiatives and/or objectives.

CUSTOMER SERVICE:

• Responsible for driving the HealthAxis culture through values and customer service standards.

• Accountable for timely and accurate handling of incoming authorizations.

• Develops and maintains positive relationships through effective and timely communication.

• Takes initiative and action to respond, resolve and follow up regarding customer service issues with all customers in a timely manner.

EDUCATION, EXPERIENCE AND REQUIRED SKILLS:

• High School diploma or general education degree (GED) required.

• Minimum one-year related customer service, administrative or related experience required.

• An equivalent combination of education, training, and experience.

• Appropriately and directly interact with other staff members and/or outside associates.

• Perform telephone and/or computer work for extended periods of time.

• Operate office equipment such as computer, telephone, and copy/scan/fax machine; attend and participate in meetings via phone, computer, or in person.

• Ability to read and interpret documents.

• Excellent communication skills including good grammar, voice, and diction.

• Ability to navigate and master proprietary software programs, and UM workflows.

• Proficient in MS Office with basic computer and keyboarding skills.

• Excellent customer service skills (friendly, courteous, and helpful).