Correspondence UM Coordinator is responsible for handling customer service or provider calls as needed. Coordinates UM processes with WellMed Medical Directors, UM Nurses, hospitals, physicians and other various departments. Correspondence UM Coordinator is responsible for providing clerical support to WellMed clinical staff for their medical necessity review process. Correspondence UM Coordinator is expected to maintain production and quality standards.
This is a fast-paced environment that requires working various shift hours and rotating/required weekends and holidays.
Primary Responsibilities:
Provides data entry, filing, tracking time frames and status of case files and mailing letters to patients and providers
Reviews denials and determines whether the decisions are retro/claims DOS or prospective DOS, and whether they are NCB or medically necessary
Monitors system approval queues and prints member letters, ensuring that all approvals are printed and mailed by end of business day
Prepares envelopes and letters for mailing according to the UM policy
Receives appeal requests from health plans and/ or QIO, logs request, researches and provides requested information
Works with claims department to redirect claims related appeal requests
Generates reports for analysis by department using the data entry system
Assists with CMS organization determination reports as needed
Must be able to work a flexible schedule that includes evening hours and holidays.
Required Qualifications:
High school diploma or GED equivalent
2+ years of related experience
Sound knowledge of medical terminology
Proficient software computer skills
Ability to work a 4-day, 10-hr per day, work week)
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