UM Coord I at ConcertoHealth
Aliso Viejo, CA, US

Job Details


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. 

• 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.