Utilization Management Correspondence Representative Senior

2 weeks ago


Wilmington, United States Elevance Health Full time

Utilization Management Correspondence Representative Senior Location: Remote Hours: Monday - Friday 12:00pm-8:30pm EST (9:00am - 5:30pm PST) Utilization Management Correspondence Representative Senior is responsible for processing and generating letters for services denied by the Utilization Management (UM) Medical Director within established Centers for Medicare and Medicaid Services (CMS) guidelines. How you will make an impact: Completes denial letters for services denied by Medical Director. Maintains updated denial letter templates. Generates and prints denial letters for mailing. Participates in department workgroups to improve processes and procedures. Provides feedback to ensure denials are handled according to CMS standards. Collaborates with other departments to produce letters for services denied in their respective units. Answers and routes incoming calls from providers, medical groups, and others verifying referral status. Minimum Requirements: HS diploma and a minimum of 2 years of experience as a UM Correspondence Rep and a minimum of 2 years of previous experience in a related field; or any combination of education and experience which would provide an equivalent background. Preferred Skills, Capabilities and Experience: Knowledge of the UM patient referral process, eligibility, benefits and Health Plan regulations, HMO/UM functions, ICD-9/CPT coding strongly preferred. For candidates working in person or remotely in the locations below, the hourly* range for this specific position is $17.20 to $25.80. Locations: California; Colorado; Hawaii; Nevada; New York; Washington State; Jersey City, NJ In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. *The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company’s sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.



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