um intake CoordinatorGenfinity

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Evolent Health has a bold mission to change the health of the U.S. by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference working in everything from scrubs to jeans.
Are we growing? Absolutely and Globally. In 2021 we grew our teams by almost 50% and continue to grow even more in 2022. Are we recognized as a company you are supported by for your career and growth, and a great place to work? Definitely. Evolent Health International (Pune, India) has been certified as "Great Places to Work" in 2021. In 2020 and 2021 Evolent in the U.S. was both named Best Company for Women to Advance list by Parity.org and earned a perfect score on the Human Rights Campaign (HRC) Foundation's Corporate Equality Index (CEI). This index is the nation's foremost benchmarking survey and report measuring corporate policies and practices related to LGBTQ+ workplace equality.
We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. If you're looking for a place where your work can be personally and professionally rewarding, don't just join a company with a mission. Join a mission with a company behind it.
UM Intake Coordinator (Philippines)
Position Summary
Be a UM Intake pioneer in this US Healthcare company that is coming soon to the Philippines! This US Healthcare company has MULTIPLE OPENINGS for UM Intake Coordinator who are energetic, eager individuals ready to join a team dedicated to assisting the Utilization Management staff on a daily basis.
For this role we are seeking skilled and knowledgeable healthcare individuals who are comfortable in providing telephone support, data entry and case routing to appropriate staff while confidently navigating several computer systems.
Roles & Responsibilities
Answers incoming queue calls to maintain established Average Speed of Answer and abandonment rates
Enters data into authorization system for admissions, outpatient procedures, therapies, home health, and DME.
Promptly records demographic information while meeting quality audit thresholds
Accurately verifies member eligibility and provider participation prior to routing case to Utilization Management Nurse, noting any discrepancies/problems in notes received from provider.
Provides provider with case reference number upon completion of data entry and /or nurse approval.
Performs initial coding of admission and surgical procedures for precertification.
Chooses appropriate ICD-10-CM and /or CPT-4 procedure code at time intake is completed.
Maintains a current knowledge base with regards to rules, regulations, policies, and procedures relating to precertification and concurrent review.
Regularly reviews and monitors compliance with company's policies and procedures.
Adheres to state and federal regulations.
Promptly makes recommendations to ensure compliance with rules, regulations, policies and procedures.
Assists with developing and updating policies and procedures as needed or requested.
Prepares medical denial letters for UM staff as requested.
Responds in an intelligent and comprehensive manner and displays a clear understanding and accurate reflection of company's goals, objectives, policies, procedures, and priorities.
Addresses inquiries independently without unnecessary or recurring contact or excessive dependence on supervisor.
Differentiate between routine and significantly sensitive matters or those issues for which direct response is inappropriate; promptly apprises immediate supervisor or assigned designee and or refers the issue to the appropriate individual.
Addresses request promptly and courteously, honors commitments and displays persistence obtaining necessary information to address issues and problems.
Hours of Training and Operations: US Business Hours
Trainees will be required to maintain regular attendance and successfully complete the required training and demonstrate proficiency of the material at the end of training.
QUALIFICATIONS:
An active and unrestricted Nursing License in the Philippines
Experience in US Healthcare is an advantage
Knowledge in utilization management process preferred
Demonstrated ability in using computer and Windows PC applications, which includes strong keyboard and navigation skills
Must possess good written and oral communications skills, organizational skills; be proficient in decision making, problem solving, and time management.
Typing speed of >25 words per minute preferred.
Ability to multitask in a fast-paced environment
Strong written communication skills
Proficient in MS Outlook, Word and Excel and general computer literacy, working with dual screens·
Ability to maintain strict confidentiality of protected health information
Willing to work any assigned shift during a work week in Makati City
Compensation & Benefits
Earn as much as ₱40,000 up to ₱50,000 per month;
HMO coverage includes you and a dependent.
Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin.
Evolent Health intends to establish a great working environment in the Philippines and offers a competitive benefit package. Candidates offered a position must be able to successfully pass the background check. * Skills testing may be required. Employees will initially be hired by Genfinity with the expectation that they will be transferred to Evolent.
Genfinity

Makati City, Metro Manila
₱50,000 per month
Permanent
Full-time