Denial & Appeal Coordinator
NAMM North America Medical Management - Ontario, CA

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Works closely with Utilization Management Department to generate timely and compliant denial letters and to facilitate the submission of appropriate appeal documentation, according to standards set. Compiles and maintains denial letter and appeal files for keeping and storage, as indicated.

Responsibilities:

Once a denial is issued, responsible for development and timely submission of denial letters, within the set parameters of NAMM California and contracted Health Plans. These letters include, but are not limited to: denials generated for denied pre-authorization requests.

Once an appeal is filed, responsible for the coordination and timely submission of a response to the health plan (e.g. clinical documentation, copies of referral requests and denial letters), within the set parameters of NAMM California and the appropriate Health Plan. These appeals include: appeals generated from denials on acute inpatient stays, pre-authorization requests and SNF level of care issues.

Qualifications:

High school graduate with 2+ years in health care delivery setting at hospital, clinic, or physician’s office or mid level administrative experience. Previous UM denial and appeal experience preferred.