Utilization Management Intake Coordinator remote- MediGold Health Plan

Why MediGold?

MediGold is a not-for-profit Medicare Advantage insurance plan serving seniors and other Medicare beneficiaries across the United States. Were dedicated to providing excellent customer service, cost-effective care, and exceptional healthcare coverage. We rely on talented colleagues in a wide variety of professional roles including information technology, financial analysis, audit, provider relations and more.

Position Purpose

The Utilization Management Intake Coordinator provides administrative support to the medical management department, including data input of members hospitalized and precertification relating to medical care. The Coordinator acts as a liaison to home medical provider and physician offices by communicating determinations and qualification of home medical equipment items for members based on Medicare criteria. The Coordinator manages member data accuracy from intake through confirmation and completion for home medical equipment authorizations. Provides guidance and resolution

on problems.

What You Will Do:

• Liaison/Coordinator for all durable home medical requests, transitions and completions. Provide follow up denial letters when necessary to member and physician.
• Responsible for completion of all new referrals which includes gathering information for approval. Once approved, referral is completed with necessary documentation of details.
• Produces reports used in coordination of utilization activities using Crystal software
• Processes all incoming telephone calls, takes messages accurately and directs calls appropriately to others in the department.
• Responsible for properly documenting all home medical equipment referrals and entering required data in computer system.
• Processes all outpatient procedures, including outpatient surgeries, obtaining necessary information from physician's office required based on specific criteria and documenting it in computer system.
• Responsible for daily input of all inpatient admissions into database with proper ICD/ CPT coding for utilization review nurses.
• Data entry of Health Risk Assessments into Access Database and mailing of postcard reminders to members who have not returned Health Risk Assessments timely.
• All other duties as assigned.

Minimum Qualifications:

• Education: High School graduate required. Bachelors degree preferred.
• Experience: Experience in HMO insurance company setting preferred. Three years of office related experience with a minimum of two years in a health related field..
• Must have strong computer skills, including: Microsoft Office Suite and data entry
• Familiarity with managed care and claims processing required, including CPT & ICD-9 coding, phone triaging, referrals and authorizations.
• Knowledge of managed care issues related to utilization management, HCFA regulations, plan benefits and provider contacts.
• Ability to work with physician offices in facilitating approval of home medical equipment authorization.

Position Highlights and Benefits:

• Competitive compensation and benefits packages including medical, dental, and vision with coverage starting on day one.
• Retirement savings account with employer match starting on day one.
• Generous paid time off programs.
• Employee recognition programs.
• Tuition/professional development reimbursement starting on day one.
• Relocation assistance (geographic and position restrictions apply).
• Discounted tuition and enrollment opportunities at the Mount Carmel College of Nursing.
• Employee Referral Rewards program.
• Mount Carmel offers DailyPay - if youre hired as an eligible colleague, youll be able to see how much youve made every day and transfer your money any time before payday. You deserve to get paid every day!
• Opportunity to join Diversity, Equity, and Inclusion Colleague Resource Groups.

Ministry/Facility Information:

Mount Carmel, a member of Trinity Health, has been a transforming healing presence in Central Ohio for over 135 years. Mount Carmel serves over 1.3 million patients each year at our five hospitals, free-standing emergency centers, outpatient facilities, surgery centers, urgent care centers, primary care and specialty care physician offices, community outreach sites and homes across the region. Mount Carmel College of Nursing offers one of Ohio's largest undergraduate, graduate, and doctor of nursing programs. If youre seeking a rewarding career where your purpose, passion, and desire to make a difference come alive, we invite you to consider joining our team. Here, care is provided by all of us For All of You!

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.