MagnaCare
UM Coordinator – MagnaCare
We are looking for a UM Coordinator at MagnaCare to coordinate all aspects of the prior authorization process, including member eligibility and benefit verification, gathering necessary clinical information from electronic medical records, and timely communication with members, providers, and facility staff. Candidates should possess knowledge of third‑party reimbursement regulations and medical terminology. Success in this role will require strong interpersonal communication, critical thinking, and problem‑solving skills. The successful candidate will interact and communicate effectively with internal and external customers, providers in clinical settings, and all members of the organization.
Primary Responsibilities
Research and confirm authorization requirements and communicate to members, providers, and facility staff
Collect data upon notification from patient/patient representative, physician, or hospital; verify member eligibility, plan participation, and provider participation status
Create cases within the documentation system in accordance with departmental workflows, policies, and procedures
Identify and correctly attach clinical documentation to appropriate cases within the documentation system
Interact telephonically with members, providers, and facilities to determine requests for type of care, including inbound and outbound calls as needed
Maintain accurate documentation within the clinical record according to workflows, policies and procedures
Collaborate with the clinical team to address provider or member questions, issues, or concerns
Play an active role in continuous improvement activities and quality initiatives to support positive outcomes for members, providers, and clients
Maintain professional communication with all internal and external stakeholders
Essential Qualifications
HS diploma or GED required
Strong skills in medical record review
Knowledge of CPT codes (preferred)
Prior knowledge of JIVA (preferred)
Excellent customer service and communication skills
Strong attention to detail and accuracy
Ability to define problems, obtain data, and establish facts
Proficient computer skills (PC) with working knowledge of Microsoft Word and Excel
Excellent data entry skills
Bachelor’s degree preferred, but not required
Familiarity with medical terminology required
Familiarity with third‑party payor processes and procedures strongly desired
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Primary Responsibilities
Research and confirm authorization requirements and communicate to members, providers, and facility staff
Collect data upon notification from patient/patient representative, physician, or hospital; verify member eligibility, plan participation, and provider participation status
Create cases within the documentation system in accordance with departmental workflows, policies, and procedures
Identify and correctly attach clinical documentation to appropriate cases within the documentation system
Interact telephonically with members, providers, and facilities to determine requests for type of care, including inbound and outbound calls as needed
Maintain accurate documentation within the clinical record according to workflows, policies and procedures
Collaborate with the clinical team to address provider or member questions, issues, or concerns
Play an active role in continuous improvement activities and quality initiatives to support positive outcomes for members, providers, and clients
Maintain professional communication with all internal and external stakeholders
Essential Qualifications
HS diploma or GED required
Strong skills in medical record review
Knowledge of CPT codes (preferred)
Prior knowledge of JIVA (preferred)
Excellent customer service and communication skills
Strong attention to detail and accuracy
Ability to define problems, obtain data, and establish facts
Proficient computer skills (PC) with working knowledge of Microsoft Word and Excel
Excellent data entry skills
Bachelor’s degree preferred, but not required
Familiarity with medical terminology required
Familiarity with third‑party payor processes and procedures strongly desired
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