UM Coordinator

Monterey Park, CA 91754

Employment Type: Direct Job Category: Medical Administrative Job Number: 46317
Want to work for one of the highest rated best companies in Los Angeles? Have a passion for healthcare and looking for a large organization to build your career? You have found the perfect match!! Medical Management company in Alhambra has an immediate need for a UM Denial Coordinator.
Job Function:
Review and process deferrals or denials
Document reasoning for denial
Evaluating referrals from multiple internal and external sources
Preparing and maintaining case management reports to ensure compliance standards are met
Meeting deadlines and sending 30-40 denial letters per day
Check on pending deferrals and follow up with providers to ensure timely response
Ensure denial packet has been reviewed and completed prior to finalizing
Create denial packages consisting of denial letters, authorization requests, evidence of receipt, clinical guidelines, medical records, etc.
Reviewing authorization
Following up with Doctor's office
Assisting Case Manager with clerical and administrative needs
Re-verifying benefits and eligibility of cases
Special Talents:
Strong follow up skills
Ability to communicate with both internal staff and external contacts
Very conscientious and confidential
Deadline driven
Requirements:
2-3+ years experience working in Utilization Management
Experience working in a managed care environment, IPA or MSO
Microsoft applications and EZ CAP experience preferred
Medical terminology, RVS, CPT, HPPCS, ICD-9 codes
Current knowledge of Managed Care UM procedures
Paying $15-$17
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