Evolent
Coordinator,UMIntake
“Coordinator, UM Intake at Evolent. Skills: process management, cross-functional coordination, vendor/stakeholder management, operational metrics, resource planning, continuous improvement. Prepare inbound faxes for coordinator processing which includes reviewing content and label editing to ensure accurate document classification.. Review Service Level Agreement Grids to determine appropriate turnaround timeframes (TAT) based on health plan, product type, line of business, code and priority.”
What You'll Achieve.
Meet established UM Intake Objective and Key Results.
Industry & Context.
identity verification steps, submission of a government issued photo ID, identity verification during interviews, final interviews may require onsite attendance, comprehensive background check, in-person I-9 verification, may be subject to drug screening prior to employment, use of artificial intelligence tools during interviews is prohibited and monitored, Misrepresentation will result in immediate disqualification from consideration, High speed internet over 10 Mbps, ability to plug in directly to the home internet router
What They're Looking For.
Must Have
A high school diploma or GED., 1 – 3 years of experience in a population management or managed care/insurance or hospital medical management department setting., Basic knowledge of medical records with the ability to locate and verify member details., Familiarity with health insurance lines of business (Commercial, Medicare, Medicaid) to correctly identify and classify incoming documents based on plan type., Working knowledge of medical coding system including CPT/HCPCS codes to differentiate between medical and pharmacy prior authorization requests., Ability to adapt to fluctuating situations and perform work of a detailed nature, while avoiding errors., Proficient using computer and Windows PC applications (Outlook, Word, Excel and OneNote), which includes keyboard and navigation skills., Team oriented, demonstrates a work ethic and committed to productivity.
Nice to Have
Demonstrated ability meeting established goals while balancing a workload and prioritizing assignments in a remote environment.
What You'll Do.
Prepare inbound faxes for coordinator processing which includes reviewing content and label editing to ensure accurate document classification.
Review Service Level Agreement Grids to determine appropriate turnaround timeframes (TAT) based on health plan
Accurately calculate and document the TAT.
Monitor the failed fax dashboard to identify unsuccessful transmissions and coordinate the re-sending of correspondence via appropriate channels.
Oversee and respond to requests in a shared email inbox by reviewing clinician inquires
retrieving requested clinical documents and attaching them for timely case review.
Assist with additional administrative tasks as assigned
demonstrating flexibility
and the ability to adapt to evolving department needs.
How You'll Work.
Team & Collaboration
support to the Utilization Management Team; support administrative operations; works with our prior authorization and clinical review teams; work collaboratively with other UM staff including our leadership team both clinical and non-clinical
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