The UM Denial Coordinator will verify eligibility and benefits to ensure accuracy and complete the denial letter per physicians’ instructions utilizing simple and easy to understand language to ensure member understanding. The Denial Coordinator is responsible for deferral letters, modification letters, and other member notifications as needed. The UM Denial Coordinator also assists with education of new Coordinators on the denial process, and re-education of staff as needed according to departmental guidelines.
Essential Functions and Responsibilities of the Job
Create understandably worded letters, with added citation and criteria as applicable.
Ensure member letters are grammatically correct, with appropriate punctuation.
Ensure letters are sent in a timely manner to stay in regulatory compliance
Create, send and store regulatory letters as needed, to ensure compliance.
Assist with education of new team members, and as needed re-education with team members as deficiencies in practices are noted.
Add support for the licensed UM personnel in the denial process
Act as a resource to providers or members for benefit, provider, and health plan information
Demonstrate good problem-solving skills
Provide a high standard of customer service for health plan members, providers and clinic staff
Demonstrates professional and courteous communication skills.
Ability to follow company policies, procedures and directives
Ability to interact in a positive and constructive manner
Ability to prioritize, multitask with attention to detail and timeliness for task completion.