Advanced Medical Management, Inc. · 4 hours ago
UM Compliance Coordinator
Long Beach, CA
Full-time
Onsite
Entry Level
2+ years expAdvanced Medical Management, Inc. is seeking a UM Compliance Coordinator to assist the Compliance Manager in ensuring timely and efficient processing of authorization referral requests. The role involves monitoring deferral processes, communicating with providers and members regarding status notifications, and managing audit-related tasks while maintaining patient confidentiality.
Health CareHospital
Responsibilities
Monitors timeliness of the deferral process for all authorization referral requests and assists with acquiring additional information, including demographic and medical information
Responsible for initial notification of the deferred status to the provider within 24 hours, and written notification to the member and provider with 72 hour of delay
Responsible for initial notification of the denied status to the provider within 24 hours, and written notification to the member and provider
Responsible for maintaining original copies of all deferred requests for submission for medical review after additional information is submitted
Assist with denial process for all authorization referral requests that have been denied by the Medical Director, including attachment of denials in Cerecons
Processes returned mail
PCP notification of patient admissions and discharges
Makes follow up calls for CCS application status
Manage the Audit Manager application for UM issues per P&P
Runs applicable reports for the department utilizing database system (Approvals, Denials, Carve-Outs and Deferrals.)
Manage the claims reports in a timely manner
Communicates with delegation oversight from the healthplan to conduct the audits and help with the requirements of the health plan
Works on the 'Corrective Action Plan' for the health plans and actively communicating with the various departments on the audit findings
Must be familiar with the contents of AMM Policy and Procedures and laws and regulations relating to Coordinators
Performs other duties as directed by Compliance Manager
Maintain patient safety and privacy. Confidentiality is key
Must be flexible, pleasant and willing to help patients in any way needed
Qualification
Required
Two to Three years related experience and/or training; or equivalent combination of education and experience preferred
High school diploma or GED, Bachelor degree preferred
Must be able to communicate both orally and in writing
Ability to apply common sense, to read and comprehend simple instructions to carry out detailed written and/or oral instructions
Must be able to efficiently prioritize multiple high priority tasks
Must have the ability to work independently and be organized with minimal supervision
Must maintain strict confidentiality of all patient information and IPA business
Benefits
Health Coverage You Can Count On: Full employer-paid HMO and the option for a flexible PPO plan.
Wellness Made Affordable: Discounted vision and dental premiums to help keep you healthy from head to toe.
Smart Spending: FSAs to manage healthcare and dependent care costs, plus a 401(k) to secure your future.
Work-Life Balance: Generous PTO, 40 hours of sick pay, and 13 paid holidays to enjoy life outside of work.
Career Development: Tuition reimbursement to support your education and growth.
Team Fun: Paid company outings and lunches because we work hard, but we also know how to have fun!
Company
Advanced Medical Management, Inc.
Advanced Medical Management, Inc.
51-200 employees
Funding
Current Stage
Growth StageRecent News
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