Montage Health
Healthcare Services Coordinator - Aspire Health Plan
Monterey, CA
Sponsorship not specified$20k-$26kDetected 6 days ago
ComplianceExcelProcess ImprovementCustomer SupportHIPAAEHR/EMRLeadershipCommunicationCollaborationProblem SolvingCritical ThinkingTime ManagementAdaptabilityOrganizational SkillsMicrosoft Office
About the role
- Coordinate intake, entry, and processing of utilization management requests received via fax, portal, phone, and electronic submissions.
- Assist with out-of-network (OON) provider searches, wrap network verification, carve-out determinations, and Letters of Agreement (LOAs).
- Coordinate retroactive review and authorization-related claims resolution activities with claims and clinical teams.
Responsibilities
- Support denial and modification workflows, including preparation, distribution, and documentation of adverse determination notices.
- Manage additional information requests for incomplete authorization submissions and follow up with providers as needed.
- Monitor and manage daily letter reporting processes and ensure timely filing and tracking of documentation.
- Attach and maintain fax confirmations and supporting records in accordance with departmental procedures and audit standards.
- Provider and Member Support
- Answer inbound calls, manage voicemail queues, and respond to departmental email inquiries in a timely manner.
- Develop and maintain positive working relationships with provider offices, delegated entities, hospitals, and community partners.
- Compliance and Regulatory Support
- Support audit readiness through accurate documentation, tracking, and adherence to turnaround time standards.
Requirements
- Experience handling high-volume administrative workflows with strong attention to accuracy and detail.
- Proficiency with Microsoft Office applications, including Excel, Outlook, and Word.
- Ability to prioritize multiple assignments and meet regulatory and operational deadlines.
- Ability to work independently and collaboratively in a fast-paced environment.
- Process expedited authorization requests and assist with required outreach and documentation.
- Generate, distribute, fax, upload, and maintain authorization-related correspondence, letter logs, and required UM reports.
- Required Qualifications
- Associate degree or equivalent combination of education and relevant experience.
- Minimum of 3-5 years of experience in managed care, health insurance, utilization management, medical office operations, claims, or provider services.
- Working knowledge of medical terminology, insurance terminology, CPT/HCPCS/ICD coding, and authorization processes.
- Strong written and verbal communication skills.
- Strong customer service and problem-solving skills.
Nice to have
- Experience supporting Medicare Advantage and Commercial managed care operations.
- Knowledge of CMS, HIPAA, NCQA, and utilization management regulatory requirements.
- Bilingual English/Spanish preferred.
- Core Competencies
- Organizational and Time Management Skills
- Attention to Detail and Accuracy
- Regulatory Compliance Awareness
- Critical Thinking and Problem Solving
Compensation
- $20k-$26k
Benefits
- Welcome to Montage Health's
- Perform preliminary review of authorization requests for completeness, required documentation, eligibility verification, and benefit coverage.
- Route and escalate requests requiring clinical review to the appropriate nurse or medical director in accordance with UM guidelines and turnaround time requirements.
- Maintain accurate records within health plan systems, databases, and tracking tools.
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This listing is sourced directly from Montage Health's careers page and normalized into a canonical job model.