Utilization Management (UM) Coordinator
Location: Loma Linda, CA
Pay: $28.00 - $30.00/hour
Assignment Length: Approximately 21 weeks
Schedule: Monday-Friday | Full-Time
Position Overview:
We're seeking an experienced Appeals & Denials Coordinator to join a busy healthcare organization in Loma Linda. In this role, you'll be responsible for reviewing denied claims, preparing and submitting appeals, and working with insurance carriers to ensure timely reimbursement. This is an excellent opportunity for someone with strong revenue cycle experience who thrives in a fast-paced environment and is passionate about maximizing claim resolution.
Key Responsibilities:
- Review, investigate, and resolve insurance claim denials.
- Prepare and submit first-level and complex appeals to commercial and government payers.
- Analyze Explanation of Benefits (EOBs) and Remittance Advice (ERAs) to identify denial trends.
- Follow up with insurance companies regarding outstanding appeals and denied claims.
- Research payer policies and ensure appeals are submitted within timely filing guidelines.
- Document account activity accurately and maintain detailed records of all follow-up efforts.
- Collaborate with billing, coding, and clinical teams to obtain supporting documentation.
- Identify opportunities to improve reimbursement processes and reduce future denials.
Qualifications:
- Minimum of 2 years of experience in medical billing with a strong focus on appeals and denials.
- Knowledge of commercial insurance, Medicare, and Medi-Cal billing guidelines preferred.
- Experience with CPT, ICD-10, and HCPCS coding is a plus.
- Strong understanding of revenue cycle management and insurance reimbursement processes.
- Basic Life Support (BLS) certification is required.
- Nationally recognized certification in Utilization Management, Utilization Review, Hospital Utilization, Managed Care, or a related healthcare field is preferred.
- Current California Licensed Vocational Nurse (LVN) license is preferred. Medical Terminology certification may be accepted in lieu of an LVN license.
- Excellent analytical, problem-solving, and communication skills.
- Ability to prioritize workload and meet deadlines in a fast-paced environment.
- Experience with electronic medical records (EMR) and billing software preferred.
Apply today! We'd love to speak with experienced Appeals & Denials Coordinators who are ready to make an immediate impact.
Pay: $28.00 - $30.00 per hour
Benefits:
- Health insurance
- Paid time off
- Vision insurance
Work Location: In person
