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Correspondence Coordinator

4 months ago

Orange, United States Alta Hospitals Full time

The Correspondence Coordinator prepares all delayed decision, carve out and denial letters for all networks. Sends appropriate correspondence to provider, member, and health plan. Compliant with PA and Health Plan Standards. Compliant with health plan reporting and adheres to all compliance regulations and timeliness standards.

Prepare delayed decision, carve-out and denial letters daily, following the PA and Health Plan timeliness standards.|Maintain accurate logs for health plan reporting. Maintain organized file system by network for all correspondence in system.|Process accurate denial reasons using correct templates and grids per PA and Health Plan standards.|Responsible for timely development of denial letter language and member/provider notification of Medical Director decision.|Audits pull and prepare requested denial and delayed decision letters for Health Plan audits. Attend denial letter training.

Three (3) years experience with Medical Group Denial letter process required. WPM 50 (minimum) required. Experience and knowledge of Microsoft Office, Word and proficient computer skills. Ability to write business correspondence. Ability to effectively present information and respond to questions from managers, employees, and Medical Directors. Maintains member confidence and protects operations by keeping claim information confidential in compliance with HIPAA requirements. Ability to work in a fast-paced office environment meeting operational and compliance timeframes.High School Diploma or GED