CLIN ADMIN COORD

Our client is currently seeking a CLIN ADMIN COORD What does this position accomplish for the business: • Correspondence UM Coordinator is responsible for handling customer service or provider calls as needed. • Coordinates UM processes with Clients Medical Directors, UM Nurses, hospitals, physicians and other various departments. • Correspondence UM Coordinator is responsible for providing clerical support to clients 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. • Generate reports for analysis by department using the data entry system. • Assists with CMS organization determination reports as needed. Required Qualifications: • High school diploma or GED equivalent. • 2+ years of related experience. • Sound knowledge of medical terminology. • Proficient software computer skills. Preferred Qualifications: • Related experience in healthcare. • Telephonic and/or telecommute experience. • Familiarity with ICD-9 coding. • Demonstrated excellent verbal and written skills. • Proven ability to possess planning, organizing, conflict resolution, negotiation, and interpersonal skills. • Independent problem identification/resolution and decision-making skills. • Demonstrated ability to interact with individuals and with multidisciplinary teams. • Ability to demonstrate excellent customer service with patients, providers, and health plan and interacting with other internal departments within the organization. How would you prefer to interview (Video phone or in person & how many rounds): Video per Teams Apply tot his job Apply To this Job