Utilization Management Denial Coordinator

Updated: about 2 months ago
Location: Los Angeles, CALIFORNIA


  • JOB DUTIES

Description

Take on a high-impact role within a world-class health organization. Help drive the continued delivery of exceptional patient care. Take your career to the next level. You can do all this and more at UCLA Health. In this key position, you will be the primary point of contact for receiving and resolving member denials. You will review denials for accuracy, confirming the receipt of necessary documentation to support the denial and ensuring compliance with all contractual obligations and state and federal laws/regulations. You will extrapolate and summarize essential information for the UM Manager and Medical Director and regularly meet with them for clinical guidance in resolving cases. You will also document appeals in the tracking system and maintain relevant statistical data. Salary Range: $22.03 – $43.68 Hourly



  • JOB QUALIFICATIONS

Qualifications

We’re seeking a results-driven, quality-focused, self-motivated team player with: * High school diploma, GED or equivalent * Three or more years of managed care experience (e.g., MSO, IPA, or health plan) * In-depth knowledge of medical terminology * Understanding of the HMO referral process, eligibility verification, and health plan benefit interpretation * Strong communication, interpersonal, organizational, and multi-tasking skills * Exceptional critical thinking, analytical, and problem-solving abilities * Proven execution and follow-up skills * Computer proficiency with Microsoft Office * Ability to cope well with ambiguity and stressful situations * Ability to maintain confidentiality of patient and business records * Ability to thrive within a complex academic medical center * Ability to develop, implement, and evaluate methods and systems to improve efficiency * Ability to lead and facilitate cross-functional workgroups and other meetings * Expertise in achieving compliance with regulatory requirements * Strong service orientation UCLA Health is a world-renowned health system with four award-winning hospitals and more than 250 community clinics throughout Southern California, as well as the David Geffen School of Medicine. Through the efforts of our outstanding people, we have become Los Angeles’ trusted provider of exceptional, compassionate patient care. If you’re looking to experience greater challenge and fulfillment in your career, you can at UCLA Health.



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