Coordinator, UM Intake

Your Future Evolves Here Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones. Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business. Join Evolent for the mission. Stay for the culture. What You’ll Be Doing: The Coordinator, UM Intake at Evolent provides support to the Utilization Management Team. The coordinator will support administrative operations by ensuring the efficient intake, review and processing of documents. The general administrative support given will contribute to the overall effectiveness of the department. Collaboration Opportunities: The Coordinator, UM Intake reports directly to the Manager, UM Intake. In support of our daily operations this individual also works with our prior authorization and clinical review teams. Opportunities to work collaboratively with other UM staff including our leadership team both clinical and non-clinical may also be available. What You Will Be Doing: Prepare inbound faxes for coordinator processing which includes reviewing content and label editing to ensure accurate document classification. Review Service Level Agreement Grids to determine appropriate turnaround timeframes (TAT) based on health plan, product type, line of business, code and priority. Accurately calculate and document the TAT. Monitor the failed fax dashboard to identify unsuccessful transmissions and coordinate the re-sending of correspondence via appropriate channels. Oversee and respond to requests in a shared email inbox by reviewing clinician inquires, retrieving requested clinical documents and attaching them for timely case review. Assist with additional administrative tasks as assigned, demonstrating flexibility, strong attention to detail, and the ability to adapt to evolving department needs. Meet established UM Intake Objective and Key Results.

Qualifications

Required and Preferred: A high school diploma or GED. (Required) 1 – 3 years of experience in a population management or managed care/insurance or hospital medical management department setting. (Required) Basic knowledge of medical records with the ability to locate and verify member details. (Required) Familiarity with health insurance lines of business (Commercial, Medicare, Medicaid) to correctly identify and classify incoming documents based on plan type. (Required) Working knowledge of medical coding system including CPT/HCPCS codes to differentiate between medical and pharmacy prior authorization requests. (Required) Ability to adapt to fluctuating situations and perform work of a detailed nature, while avoiding errors. (Required) Proficient using computer and Windows PC applications (Outlook, Word, Excel and OneNote), which includes strong keyboard and navigation skills. (Required) Team oriented, demonstrates a strong work ethic and committed to productivity. (Required) Demonstrated ability meeting established goals while balancing a workload and prioritizing assignments in a remote environment. (Preferred) To ensure a secure hiring process we have implemented several identity verification steps, including submission of a government issued photo ID. We conduct identity verification during interviews, and final interviews may require onsite attendance. All candidates must complete a comprehensive background check, in-person I-9 verification, and may be subject to drug screening prior to employment. The use of artificial intelligence tools during interviews is prohibited and monitored. Misrepresentation will result in immediate disqualification from consideration. Technical Requirements: We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router. Evolent is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status. If you need reasonable accommodation to access the information provided on this website, please contact [email protected] for further assistance. The expected base salary/wage range for this position is $. As part of our total compensation package, Evolent is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees. All compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts. Apply To This Job