Are you a highly organized, detail-oriented professional with a solid understanding of ICD-9/10 and CPT coding? Do you thrive in a fast-paced environment while providing excellent customer service? If so, we have the perfect opportunity for you!

We are seeking a dedicated Outpatient Utilization Management (UM) Coordinator to join our dynamic team. This role is essential for ensuring timely, accurate, and efficient processing of referrals and authorizations while maintaining the highest level of customer service. As a UM Coordinator, you’ll collaborate with inter-departmental teams and work directly with providers to meet the needs of our members.

Key Responsibilities:

Monitor the Right Fax Server to ensure all referrals are processed accurately and within required timeframes.

Review referral forms for completeness, obtain missing demographic information, and initiate coding for uncoded referrals.

Maintain accuracy in referral authorizations and ensure compliance with established standards.

Provide professional and courteous responses to provider calls, representing the company with professionalism at all times.

Collaborate with Utilization Management Nurses to process authorizations, modifications, and denials, ensuring clear communication with providers regarding authorization requests.

Assist management and Utilization Management Nurses as requested to streamline operations and improve departmental efficiency.

Education & Experience Requirements:

Minimum of 3 years of experience as a data entry specialist or coordinator.

High school diploma or GED required.

Key Qualifications:

Strong working knowledge of ICD-9/10 and CPT codes.

Experience in managed care or physician office settings is highly preferred.

Proficient in computer applications, including word processing, databases, and spreadsheets.

Exceptional customer service skills with a focus on building positive, collaborative relationships with team members and providers.

Why Join Us?

Dynamic Work Environment: Be part of a team that values collaboration and growth.

Impactful Role: Play a crucial role in ensuring members receive the care and support they need.

Growth Opportunities: Expand your skills and grow within a forward-thinking organization.

If you’re a skilled professional with a passion for providing excellent service and a solid understanding of medical coding, we want to hear from you!

Apply Today and Make an Impact!

EEO/AA Employer/Vet/Disabled.

The Know Your Rights poster is available here:
https://www.eeoc.gov/sites/default/files/2023-06/22-088_EEOC_KnowYourRights6.12.pdf

The pay transparency policy is available here:
https://www.dol.gov/sites/dolgov/files/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdf

For temporary assignments lasting 13 weeks or longer, the Company is pleased to offer major medical, dental, vision, 401k and any statutory sick pay where required.

We are committed to working with and providing reasonable accommodations to individuals with disabilities. If you need a reasonable accommodation for any part of the employment process, please contact your staffing representative who will reach out to our HR team.

AppleOne participates in the E-Verify program in certain locations as required by law. Learn more about the E-Verify program.
https://e-verify.uscis.gov/web/media/resourcesContents/E-Verify_Participation_Poster_ES.pdf

We also consider qualified applicants regardless of criminal histories, consistent with legal requirements. Pursuant to applicable state and municipal Fair Chance Laws and Ordinances, we will consider for employment-qualified applicants with arrest and conviction records. For Los Angeles, CA applicants: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.