Hybrid UM Denials Coordinator – Overtime Eligible

Astrana Health, Inc.; Monterey Park (CA); Hybrid; USD 29,000 - 36,000; Full time

Benefits offered by this job

Hybrid work arrangement

Overtime opportunity

Job summary

Astrana Health, Inc. is seeking a dedicated Utilization Management (UM) Coordinator – Denials in Monterey Park, CA. This role processes prior authorization denials in line with NCQA and health plan requirements while maintaining HIPAA privacy and high accuracy standards.

The position offers a hybrid in-office/remote schedule with potential overtime based on daily volume. Requires strong knowledge of UM processes and regulatory guidelines.

Qualifications

• High school diploma or GED required.
• Knowledge of ICD-10, CPT, HCPCS, and RVS codes.
• Proficient in Microsoft Office and UM software (InterQual, MCG).
• Strong organizational, decision-making, and problem-solving skills.
• Excellent verbal and written communication.
• Typing speed of at least 40 wpm.

Responsibilities

• Adhere to policies and regulations (Health Plan, DMHC, DHCS, CMS, NCQA).
• Process deferrals and denials with documentation.
• Review eligibility and benefits verification.
• Communicate with providers and departments to ensure service quality.
• Process daily deferrals/denials per guidelines and timelines.
• Verify member eligibility and benefits for deferrals/denials.
• Maintain UM/Denial system data and turnaround times.
• Apply denial templates per LOB and guidelines.
• Ensure correct criteria and reading level for denials.
• Ensure denial packets are complete with required docs.
• Assist with Failed Fax Reports and Inquiries.
• Report activities to UM Denial Supervisor/Manager.
• Maintain HIPAA privacy and data integrity.
• Collaborate on quality improvement initiatives.

Skills

Medical terminology

ICD-10/CPT codes

UM software InterQual MC G

Microsoft Office

Typing 40 wpm

Communication skills

Organizational skills

Education

High school diploma or GED

Tools

InterQual

MCG

Microsoft Office

Job description

Astrana Health, Inc. is seeking a dedicated Utilization Management (UM) Coordinator – Denials in Monterey Park, CA. This role processes prior authorization denials in line with NCQA and health plan requirements while maintaining HIPAA privacy and high accuracy standards.

The position offers a hybrid in-office/remote schedule with potential overtime based on daily volume. Requires strong knowledge of UM processes and regulatory guidelines.