Intake Authorization Coordinator
Health Care that Starts with You!
Join a truly mission-driven organization! Independent, nonprofit UCare is recognized as one of the Minnesota's leading health plans. We provide more than 225,000 members across Minnesota and western Wisconsin with the health coverage plans and services they need to maintain and improve their health. The innovative coverage we create makes a difference for Medicare-eligible individuals, individuals and families enrolled in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance, and disabled adults with special health care needs. UCare is growing in size, membership, products, geographic coverage, and employees. We're an organization that's going places. Be part of a team that cares about you, be part of UCare.
ABOUT UCAREAt UCare, we deliver high-quality health coverage and services to help members of all ages maintain and improve their health. It's a big job that takes innovative ideas, strategic partnerships, and a commitment to doing the right thing. Above all, it takes a compassionate team that is dedicated to making a real difference in the lives of our members and our communities. WORKING AT UCAREWorking at UCare is more than just a career; it's a mission. A mission that defines us as professionals, unites us as an organization, and shapes how we interact with our members and each other. Our values of integrity, community, quality, flexibility, and respect permeate every aspect of our organization - from who we are and how we act, to what we do and how we do it. We owe our continued success to our employees who proudly embody our mission and values in everything they do. INTAKE AUTHORIZATION COORDINATOR Position DescriptionReceives and processes requests for prior authorization of Personal Care Assistance Service requests. Coordinates approval process with UR Specialist staff to assure compliance with regulatory guidelines. Discusses prior authorization process and authorization with providers. Provides assistance in tracking of requests to meet regulatory guidelines in identified areas. Prioritize and organize work in a fast-paced environment to meet regulatory requirements. Specific duties and responsibilities include: Receives prior authorization requests for Personal Care Attendant Services. Prepares request and reviews to determine appropriate authorizing entity to review.Prioritizes requests and organize work to ensure timely completion of work to meet compliance with regulatory guidelines. Reviews and enters authorization requests and assists in the determination process for identified areas. This includes contacting providers with service authorizations. Communicates and coordinates with other UCare departments and external providers to obtain information, request action or follow-up. Responds to phone calls for identified areas. This includes triaging as needed, responding to provider requests and forwarding to other areas/departments as appropriate.Monitors reports for identified areas to ensure timely responses from providers. Follows up with identified issues with an initial phone call for status checks. Forwards to Intake Manager as appropriate any trends/ongoing issues with providers. Documents all calls/interactions regarding members using established department standards.Understands, implements and supports the Evidence of Coverage (EOC), Certificate of Coverage (COC), organization policies, department procedures, state rules and protocols. Demonstrates proficient use of computer systems required to perform assigned duties. Meets productivity and quality measures established by the department. Other projects and duties as assigned.
EducationHigh school diploma or equivalent required. Completion of medical assistance, health unit coordinator or other medical certificate required. Required ExperienceUse and understanding of medical terminology, CPT, ICD-9 coding and insurance policies. Understanding of the Personal Care Assistance homecare service.Preferred ExperienceExperience with insurance operations, member or provider customer service, or Managed Care utilization review. Experience in hospital, clinic or other health care facility/provider. THE UCARE DIFFERENCEUCare is proud to be a recognized Star Tribune Top Workplace for the 9th consecutive year. As a part of our collaborative team, you'll experience the rewards that come with helping others and seeing the positive results of your hard work. We value and respect each individual's ideas and contributions, and give you the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, a myriad of volunteer activities, and a number of other rewards. If you're looking for a welcoming environment that celebrates what you have to offer, helps you build on your strengths, and gives you the opportunity to truly make a difference, we invite you to apply. As an Equal Opportunity/Affirmative Action Employer, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.
Enter a highly collaborative environment where people are truly engaged, and feedback is valued. You'll enjoy a competitive salary and benefits, as well as a host of other perks, including a nationally recognized wellness program, and a bright, open, award-winning office space in Northeast Minneapolis just minutes from major freeways and retail centers.
At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.