Central Denials Unit Coordinator

What are we looking for in our Central Denials Unit Coordinator?

A Health Financial Service is looking to hire a Central Denials Unit Coordinator.

Location: Remote in CA

Pay: $20-22/ hourly

Contract: 4 Month Contract

You will be responsible for providing non-clinical support to the utilization management team in maintaining and managing the utilization processes for pre-service authorization requests in a timely and accurate manner consistent with policies and procedures as described in the Utilization Management plan.

Responsibilities:

• Consistently exhibits behavior and communication skills that demonstrate commitment to superior customer service, including quality, care and concern with each and every internal and external customer.
• Performs all functions of the care coordinator.
• Provides non-clinical support to the CDU nurse in the processing of all adverse determinations and notices including provider outreach for denial avoidance, accessibility verification and benefit validation.
• Ensures informational notices for carve outs and benefits are composed in a manner consistent with federal regulations, state regulations, health plan requirements and NCQA standards.
• Converts service description and diagnosis into language that is easily understood based on resources provided and clinical direction.
• Validates the accuracy of all information provided in the carve out and benefit notices including carve out providers and contact information provided relevant to aforementioned notices.
• Contacts members or providers for continuity of care services related to carve out notices.
• Adheres to the standardized documentation requirements for carve out and benefit notices.
• Documents members’ service benefits by contacting the appropriate health plans.
• Directs providers and members to contracted provider network and facilities.
• Processes appropriate authorizations for HMO / PPO clients as specified in the organization’s procedures.
• Acts as a resource to other coordinators, staff and providers by resolving issues and responding to requests in a timely and effective manner.
• Works with patient services regarding member concerns.
• Identifies gaps in training or process impacting the overall compliance of adverse determinations and communicates in writing an effective performance improvement solution.
• Meets or exceeds productivity targets.
• Uses, protects, and discloses patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
• Performs additional duties as assigned.

Requirements:

• 1 year of experience performing non-clinical functions for prospective UM review.
• Preferred:
• 1 year of experience providing supportive or direct functions for adverse determinations.
• 3 to 5 years of experience in a health care setting.
• 2 years referrals management or related experience.
• High school diploma, G.E.D. or equivalent. Includes special certification required for specific jobs.
• Certificate in a healthcare related field preferred.
• Computer literate.
• Proficient in Microsoft Office Suite, knowledge of utilization management platforms and the capacity to navigate varied health plan websites for benefit determinations.
• Ability to type 30 wpm.
• Broad knowledge of managed care principles.
• Knowledge of medical terminology and CPT/ICD-9 coding.
• Excellent communication, organization and customer service skills.
• Proven ability to problem-solve.
• Strong attention to detail.

Pride Global offers eligible employee’s comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), a 401(k)-retirement savings, life & disability insurance, an employee assistance program, identity theft protection, legal support, auto and home insurance, pet insurance, and employee discounts with some preferred vendors.

As a certified minority-owned business, Pride Global and its affiliates - including Russell Tobin, Pride Health, and Pride Now - are committed to creating a diverse environment and are proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, pregnancy, disability, age, veteran status, or other characteristics.

Russell Tobin is a leading minority-owned professional and technical recruitment and staffing advisory organization.

We are comprised of specialized practices focusing on a variety of skill sets and industries. Having a depth and breadth of industry expertise, our subject matter experts are able to provide tailored and swift sourcing solutions to fulfill client hiring needs. In other words, we connect top talent with companies.

We are the staffing arm of the Pride Global network, a minority-owned integrated human capital solutions firm, with additional offerings in vendor management, payroll programs, and business process optimization.

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Rate/Salary: Pay: $20-22/ hourly