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