Job Description

Summary

The Outpatient UM Member and Provider Notification Coordinator will report directly to Lead/Supervisor. Their primary role is to provide timely notifications to members/providers of a referral authorization and assist the member with specialist appointments.

Duties and Responsibilities:

• Maintain knowledge of standard regulations for decision and notification turnaround timeframes for all lines of business (Medi-Cal, Commercial, & Medicare) 
• Provide member notification 
  • Make outbound calls to notify members of a referral/authorization
  • Receiving and responding to member inbound phone calls
  • Research member’s history for current phone numbers
  • Validate current phone and fax numbers for both members and providers
  • Actively listen to members and identify their needs  
  • Assist with scheduling appointments 
  • Communicate unable to contact (UTC) members to Case Management team with complex care diagnosis i.e. major organ transplant candidate, high risk diagnosis 
• Provide Primary Care Physician (PCP) and/or Specialist Care Provider (SPC) notification
  • Outreach PCP or SPC for additional medical records for referral/authorization
  • Review failed fax report daily 
  • Outreach SPC when a failed fax has been identified to rectify the providers fax number and re-fax notification
• Document member and provider outreach in EZCAP 
• Escalate issues to direct lead as appropriate 
• Read and maintain email inquiries 
• Collaborate with other departments (i.e. Claims, PNO, etc.) to resolve member/provider matters as needed 
• Assist with special projects, as needed
• Assists other team members with their workload, as needed
• Regular attendance at UM team meetings

Minimum Job Requirements:

• High School graduate or GED equivalent
• One-year medical office experience
• Bilingual 
• Knowledge of medical terminology
• Proficiency in Microsoft Office programs, especially Word and Excel
• Proficiency in EZCAP a plus

Skills and Abilities:

• Strong customer service skills with good telephone rapport

• Ability to multi-task while remaining adaptable and flexible to fast-paced environment
• Ability to empathize with complex cases 

• Reliable, dependable, and accountable
• Self-Motivation and ability to work effectively in an independent environment 
• Great critical thinking and problem-solving skills

Salary:

• $21 – $22 hourly

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