Utilization Management Correspond Rep ; Senior
Posted on: 18 Jan 2021
Woodland Hills, CA
Job Description
Description
SHIFT: Day Job
SCHEDULE: Full-time
Your Talent. Our Vision. At Anthem, Inc., its a powerful combination, and the foundation upon which were creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.
This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health care companies and a Fortune Top 50 Company.
The Utilization Management Correspond Rep & 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.
Primary duties may include, but are not limited to:
Completes denial letters for services denied by Medical Director.
Generates and prints denial letters for mailing.
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. Identifies opportunities to enhance workflow and offers solutions.
Answers and routes incoming calls from providers, medical groups, and others verifying referral status.
Qualifications
Utilization Management Correspond Rep
Requires a high school diploma; 2 years of experience in a managed care delivery system and/or Utilization Management; or any combination of education and experience, which would provide an equivalent background.
Knowledge of the UM patient referral process, eligibility, benefits and Health Plan regulations, HMO/UM functions, ICD-9/CPT coding required.
Utilization Management Correspond Rep Sr
Requires a high school diploma; 2 years of experience as a UM Correspondence Rep, including 2 years of previous experience in a related field; or any combination of education and experience, which would provide an equivalent background.
Knowledge of the UM patient referral process, eligibility, benefits and Health Plan regulations, HMO/UM functions, ICD-9/CPT coding required.
Anthem, Inc. is ranked as one of Americas Most Admired Companies among health insurers by Fortune magazine and is a 2018 Diversity Inc. magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.
Anthem, Inc.
Indianapolis, IN
Anthem, Inc., through its subsidiaries, operates as a health benefits company in the United States. It operates through three segments: Commercial & Specialty Business, Government Business, and Other. The company offers a spectrum of network-based managed care health benefit plans to large and small group, individual, Medicaid, and Medicare markets. Its managed care plans include preferred provider organizations; health maintenance organizations; point-of-service plans; traditional indemnity plans and other hybrid plans, such as consumer-driven health plans; and hospital only and limited benefit products.
The company also provides a range of managed care services to self-funded customers, including claims processing, underwriting, stop loss insurance, actuarial services, provider network access, medical cost management, disease management, wellness programs, and other administrative services. In addition, it offers an array of specialty and other insurance products and services, such as dental, vision, life and disability insurance benefits, radiology benefit management, and analytics-driven personal health care guidance; and Medicare administrative services.
Further, the company provides services to the federal government in connection with the Federal Employee Program; and operates as a licensee of the Blue Cross and Blue Shield Association. As of December 31, 2018, it served 40 million medical members through its affiliated health plans. The company was formerly known as WellPoint, Inc. and changed its name to Anthem, Inc. in December 2014. Anthem, Inc. was founded in 1944 and is headquartered in Indianapolis, Indiana.
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IndustryHealthcare
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No. of Employees63,900
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Website
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Jobs Posted1634
