This position is responsible for processing all of the UM department’s written/verbal determination notifications. The UM Coordinator I is responsible for processing administrative and medical (directed by the Medical Director) adverse organizational determinations according to contractual policies and procedures and completes required documentation within established timeframes.
ESSENTIAL DUTIES AND RESPONSIBILITIES
• Process medical approval and denial correspondence letters within established timeframes, in accordance to policies, procedures, and contractual requirements.
• Document denial and denial rationale in data management systems.
• Create and mail required approval and denial documentation with member-specific information to providers and members.
• Provide information on denials as requested.
• Review file for completeness of required documentation, including but not limited to, confirmation of receipt of notification, copies of written notification, correspondence with members and providers.
• Be a resource to providers and ConcertoHealth staff regarding specific denials and/or denial process.
• Provide requested information during appeals process.
• Assist other departments in creating denial documentation as requested.
• Complete other duties and special projects as assigned.
• High School diploma or GED.
• Typing 45wpm.
• Knowledge of Medical Terminology.
• Minimum two (2) years’ experience in managed care or health care setting.
• Ability to navigate multiple PC applications simultaneously. Knowledge and experience using Microsoft ® Office required.
• Excellent written/verbal communication skills, proficiency with basic grammar and spelling, and strong attention to detail.
• Ability to work in a fast-paced environment and maintain a high level of productivity.
• Ability to prioritize and handle multiple tasks effectively and efficiently, remain flexible, and adapt to shifting work demands.
• Strong organizational and time management skills. Able to work independently, but also as a team player.
• Ability to convey a positive and professional image to customers and employees.
• Willingness to embrace and promote change as required by the needs of the business.