Coordinator Ucmg

Lakeside Medical Orange , CA 92856

Posted 7 days ago

As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us.

We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.

We currently have an openings for a Vital Care Coordinator

The role of the Vital Care Coordinator is to promptly, efficiently and accurately execute all aspects of the referral process. Promote the quality and cost effectiveness of medical care through strict adherence to all UM Policy and procedure.
1.Anticipate our customer needs: Understand the wants and needs of customers, listen for cues and identify how to respond and what level of intervention they need
2.Understand and execute the principles of UM to facilitate the right care at the right time in the right setting.
3.Communicate effectively and interact with the provider group and health plans daily or as indicated regarding UM and referral authorization issues.
4.Data entry via GCEA/REA
5.Process request that are approved, denied or deferred and bring them to resolution.
6.Responsible for Deferred authorization maintenance, tracking and follow up.
7.Responsible for the EIOD process, including log maintenance; and patient notifications
8.Checks eligibility and benefits on all DME and home health authorizations prior to forwarding on request to prior authorization nurse or medical director for approval.
9.Returns phone calls to customers and follows up with requests.
10. Maintain turnaround time compliance in all aspects of the UM process.
11. Maintain all reference material that is provided by the supervisor, manager or director.
12. Know and follow the Employee Handbook policies and procedures.
13. Maintain patient confidentiality so that HIPAA compliance is observed at all times.
14. Demonstrates honesty and integrity in everyday activities.
15. Recognizes when an error has been made and immediately reports to appropriate manager.
16. Maintain regulatory Turn Around Time Standards per CMS (Seniors) and ICE (Commercial).
17. Maintains quality monitors as assigned by Supervisor.
18. Assists other staff and supports the team approach.
19. Participates in the efficient, effective, and responsible use of resources such as supplies and equipment.
20. Communicates appropriately and clearly to management, co-workers, and physicians.
21. Other Duties as assigned



icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
New Business Coordinator

The Word And Brown Companies

Posted 5 days ago

VIEW JOBS 3/15/2019 12:00:00 AM 2019-06-13T00:00 Purpose of Position: * Data entry of new groups, membership and providers. Performing quality control audits on cases entered by members of team. Support team for New Business Underwriters. Essential Functions: * Understanding of company policies and procedures as apply toChoice Administrators' programs. * Understand and process all enrollment forms submitted for the Underwriting of a new case. * Enter new case information into the system. * Log progress of case in the Data Entry Turnaround Tracking log located in the department's SharePoint site * Handle and follow-up on telephone inquiries and voicemails. * Document Broker/GA/Carrier calls in Pegasus. * Maintain an average Data Entry Error Ratio of 3% or less * Complete and attach the Submission Checklist to each new group that is processed. * Adhere to all H.I.P.A.A. guidelines. * Assist with departmental training needs as assigned by leadership team. * Distribute incoming faxes, e-mails and mail to the designated Underwriter and/or Coordinator. * Perform UAT testing on new programming as needed. * Complete miscellaneous projects as assigned. * Assist with updating Instruction Files as assigned. * Complete all monthly department reports by deadline. * Quality Control all new cases after approval. * Order office supplies for the department on a weekly basis. * Complete back up duties as needed. * On-site regular attendance and punctuality are essential functions of the job. * Performs other business tasks or functions as assigned. Requirements Knowledge, Skills, & Abilities Required: * Must have excellent verbal and written communication skills, especially under pressure. * Ability to handle irate customers in a courteous, patient, calm and positive manner while maintaining a high quality of work. * Must be computer literate in Microsoft Word, Excel and Outlook. * Must have an average typing speed of 45WPM. * Must be able to work in a fast-paced environment where deadlines are a priority and handling multiple assignments simultaneously is the norm. * Must be able to understand and follow directions * Must be a team-player and participate in a close team-oriented environment * Must be able to schedule time to complete miscellaneous projects as assigned * Must be able to test new programming as needed Educational Requirements: * Must be at least a high school graduate, insurance background a plus Physical Requirements: * Must be able to sit for extended periods of time and occasional standing and walking. Must have adequate hearing for phone work. Vision requirements include close visionand the ability to adjust focus. Must be able to communicate effectively in English. Must be able to use a keyboard and other office equipment. Ability to lift up to 10 pounds occasionally Apply On-lineSend This Job to a Friend The Word And Brown Companies Orange CA

Coordinator Ucmg

Lakeside Medical