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TH Medical

Utilization Mgmt Coordinator

TH Medical - Cypress, CA

Utilization Mgmt Coordinator','!*!Position Summary:

The Utilization Management Coordinator is responsible for

the accurate and timely processing of all requests for authorization of

services for assigned members. Responsibilities:Responsible for accurate

processing and data entry of referrals and authorizations within the time

frames set for urgent and/or routine.Assigns accurate ICD-9 and CPT

codes to requested services for referral and authorization processing.Verifies eligibility and benefits

with internal systems and manuals or with health plans if necessary.Documents in memo and/or notes

any special contractual arrangements agreed to.Directs authorizations to

contracted providers whenever possible and authorizes services at proper level

(i.e., in office rather than hospital if possible).Requests additional information

from providers when referral forms are incomplete.Responsible for timely processing

of denials and assures that appropriate information is directed to Denial

Administrator for processing of denial letters.Runs reports from EZ-Cap when

requestedProvides telephone coverage when

required.Fosters positive interaction and

relationships with all internal departments and staff, as well as external

contacts and ensures department resolution of problems.Maintains confidentiality and

professionalism with all communications.Performs other assigned duties /

special projects on an as-needed basis.


 ','!*! High school diploma (or

equivalent) preferred1 years’ experience in an IPA, or other health care companyData entry experience in a clinical setting using medical

terminology, ICD9 and CPT codingKnowledge of EZ-Cap information system preferredProficiency with PC-based computer systems 

 ','Clerical/Administrative','CA-Cypress','','Coast Healthcare','Full-time','Full-time','Days','Days','','','','','','','1805019022','Utilization Mgmt Coordinator

83 days 12 hours ago

TH Medical


Utilization Mgmt Coordinator TH Medical - Cypress, CA, United States


Location: Cypress, CA

Company Profile:
At Tenet Healthcare, we’ve had a longstanding commitment to serving our patients, our employees, our physicians and our partners. Today, we’re one of the nation’s leading healthcare services companies, with a comprehensive network that extends from coast to coast: