Brighton Health Plan Solutions · 13 hours ago
UM Denials Coordinator
United States
Full-time
Remote
Entry Level
2+ years expBrighton Health Plan Solutions is committed to improving healthcare access and delivery. The UM Denials Coordinator supports the Utilization Management function by reviewing denied authorizations and preparing denial correspondence, ensuring compliance with regulatory requirements and client-specific service level agreements.
AdviceHealth CareHospital
Hiring Manager
Paul Pascale
Responsibilities
Review denied authorization cases within the Utilization Management system to understand the clinical determination and supporting rationale prior to letter creation or finalization
Draft, edit, and format denial and partial denial letters based on authorization determinations, including accurately copying and inserting approved clinical statements, criteria citations, and physician rationale into correspondence templates
Apply working knowledge of Utilization Management processes and sound judgment to ensure all written correspondence is clear, readable, complete, and accurate
Ensure all letter content, data fields, and member, provider, and service details are accurately populated to prevent compliance risks or downstream operational issues
Communicate with physicians and nursing staff as needed to clarify determinations, obtain missing information, or resolve discrepancies prior to letter release
Prioritize and triage denied authorization cases in alignment with client-specific requirements and regulatory turnaround times
Respond to and resolve member and provider inquiries related to denied authorizations and denial correspondence
Review, investigate, and resolve items listed on the failed fax report to ensure timely and successful delivery of correspondence
Perform other related duties as assigned
Qualification
Required
High school diploma or GED required
Two or more years of healthcare administrative support experience
Two or more years of managed care experience, in Utilization Management or Appeals
Strong verbal and written communication skills
Demonstrated customer service skills, including effective written and verbal communication
Proficient in Microsoft Office applications, including Word, Excel, and Outlook, in a Windows-based environment
Ability to adapt quickly to changing business needs and learn new processes and systems
Preferred
Proficient in electronic medical records understanding and medical record documentation
2-4 years' experience as a medical assistant, office assistant or other clinical experience
Previous experience handling/reviewing UM denial letters
Proficient/Experienced with CPT4 and ICD-10 codes
Previous Member Service or Customer Service telephonic experience
Company
Brighton Health Plan Solutions
Brighton Health Plan Solutions is a health care company that specializes in health plan management service.
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
Jim Cusumano
Co-Founder, President and CEO
Recent News
Behavioral Health Business
2025-06-10
2025-04-17
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