Correspondence Coordinator (Agency)

We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.

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

Job Responsibilities/Duties

• 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.

Minimum Education: High school diploma or equivalent.

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

Req. Certification/Licensure: None.

Employee Value Proposition

Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals, benefit eligible positions will receive:

• Company 401K
• Medical, dental, vision insurance
• Paid time-off
• Life insurance

To apply for this role, or search our other openings, please visit http://pmh.com/careers/ and click on a location to begin your journey to a new career with us!

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.

EEOC is the Law: https://www.eeoc.gov/