Utilization Management Coordinator I

Utilization Management Coordinator I

Requirements

• High School Diploma or equivalent required.
• MA or Medical Billing Certificate preferred.
• Minimum 1 year of experience working in a medical billing environment (IPA or HMO preferred), with pre-authorizations and reimbursement regulations on Medi-Cal, CCS, and other government programs required.
• Prior experience working in a clinic/health care specialty call center.
• Prefer experience in utilization management, processing authorization referrals.

Responsibilities

• Provide support to the Medical Management department to ensure the timeliness of outpatient or inpatient referral/authorization processing per state and federal guidelines.
• Perform troubleshooting when problem situations arise.
• Coordinate with leadership.

Preferred Qualifications

• MA or Medical Billing Certificate preferred.
• Prefer experience in utilization management, processing authorization referrals.