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Correspondence Coordinator - TEMP

Remote: 
Full Remote
Contract: 
Experience: 
Mid-level (2-5 years)
Work from: 

Offer summary

Qualifications:

High school diploma or equivalent., Three years experience with Medical Group Denial letter process..

Key responsabilities:

  • Prepare delayed decision, carve-out and denial letters daily.
  • Maintain accurate logs for health plan reporting and organize correspondence files.
  • Process denial reasons using correct templates.
  • Verify ICE Denial Templates monthly for updates.
  • Audit and prepare requested denial letters for Health Plan audits.
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Prospect Medical Systems SME https://prospectmedicalsystems.com/
501 - 1000 Employees
See more Prospect Medical Systems offers

Job description

Job Description

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

Responsibilities

  • Prepare delayed decision, carve-out and denial letters daily, following the ICE timeliness standards.
  • Maintain accurate logs for health plan reporting to be completed for the previous month by the 5th of the following month.
  • Maintain organized file system by network for all correspondence in IDX system.
  • Process accurate denial reasons using correct templates and grids per ICE / CMS / Medi-cal / Health Plan.
  • Monthly verification of ICE Denial Templates for updates or change in language deemed required by CMS, ICE and Health Plans.
  • Responsible for timely development of denial letter language and member/provider notification of Medical Director decision.
  • Audits, pulls and prepares requested denial and delayed decision letters for Health Plan audits.
  • Attend denial letter training.

Qualifications

Minimum Education: High school diploma or equivalent.

Minimum Experience: Three (3) years experience with Medical Group Denial letter process.

Req. Certification/Licensure: None.

"Location-Based Pay Adjustment"

About Us

With approximately 9,000 physicians to serve our 260,000 members, Prospect Medical Systems is proud to be among the most innovative medical systems in California, Texas and Rhode Island. Our extensive care services range from primary care and specialty physician services to acute care hospital and skilled nursing facilities to behavioral health and wellness services. Each of our Independent Physician Associations (IPAs) and networks support the use of advanced diagnostic and treatment tools to provide our members with convenient access to state-of-the-art healthcare. For 25+ years, Prospect Medical has been focused on our mission of supporting independent physicians where, through risk arrangements, we work closely together with health plans, facilities and healthcare physicians for the benefit of every person who comes to us for care. We provide quality healthcare services that are designed to offer our patients highly coordinated, personalized care and that help them live healthier lives. Prospect Medical Systems manages highly successful IPAs by leveraging our best-practices, results-driven administrative services to manage patients under risk arrangements with health plans/CMS.

Required profile

Experience

Level of experience: Mid-level (2-5 years)
Spoken language(s):
English
Check out the description to know which languages are mandatory.

Other Skills

  • Detail Oriented
  • Record Keeping
  • Verbal Communication Skills
  • Organizational Skills

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