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UM Correspondence Rep or Sr.-  Norfolk, VA-  PS9674 in Norfolk, VA at Anthem, Inc.

Date Posted: 10/12/2018

Job Snapshot

  • Employee Type:
  • Location:
    Norfolk, VA
  • Job Type:
  • Experience:
    At least 2 year(s)
  • Date Posted:

Job Description

Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re 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 benefits companies and a Fortune Top 50 Company.
UM Correspondence Rep/ Sr.:
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. Maintains updated denial letter templates.
  • Generates and prints denial letters for mailing.
  • Participates in department workgroups to improve processes and procedures.
  • 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. 
  • 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.
  • At least 1 year od Behavioral Health and/or customer care experience
  • Call center experience in a behavioral health environment- Preferred
  • Proficient in Microsoft Word and Excel
  • Ability to maneuver and operate in Facets, Macess, and Iris Letter Hub
  • Familiarity with Behavioral Health, Medicaid and Medicare line of business
  • Comfortable with working with Medical Directors and UM staff
  • Familiarity with turn around time and CMS and NCQA guidelines
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at An Equal Opportunity Employer/Disability/Veteran


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