Job Overview
We’re looking for a proactive Pre-Service UM Coordinator to handle prior authorization requests and referral processing. You’ll work closely with nurses and case managers to ensure member services are accurately reviewed, approved, and communicated on time.
Schedule: Monday–Friday, 8:00 AM–5:00 PM PT (required)
Location: Fully Remote
Responsibilities:
- Enter prior authorization and referral requests into system with correct ICD-10 and CPT coding.
- Review incoming faxes and queues; route requests to appropriate staff.
- Collect and attach medical records to pre-service authorizations.
- Maintain documentation for provider outreach and member updates.
- Generate and send correspondence to facilities/providers as needed.
- Assist case management team with pre-service case presentations.
- Prioritize tasks to meet turnaround times while following UM guidelines.
Required Qualifications:
- Hands-on experience entering referrals and prior authorizations.
- Knowledge of Medicare Advantage, HMO/MMO, and managed care plans.
- Familiarity with medical terminology, ICD-10, and CPT codes.
- Strong computer navigation and documentation experience.
Preferred:
- Experience as a Medical Assistant or Front Office Medical Assistant
- Familiarity with Epic or health plan/provider portals (e.g., Access Express).
Skills:
- Microsoft Outlook, Excel, Word
- Typing speed ≥50 WPM
- Highly organized and detail-oriented
- Strong communication skills (phone, written, verbal)
- Able to file/systematize documentation efficiently
Education:
- High school diploma/GED OR 4 years of relevant experience
Job Type: Full-time
Pay: $20.00 - $28.00 per hour
Expected hours: 40 per week
Benefits:
- 401(k) matching
- Dental insurance
- Employee assistance program
- Employee discount
- Flexible schedule
- Health insurance
- Life insurance
- Paid time off
- Professional development assistance
- Retirement plan
- Vision insurance
Work Location: Remote
