UM Specialist: Denials & Appeals Coordinator

San Juan Regional Medical Center; San Juan (PR); Presencial; USD 42.000 - 54.000; Jornada completa

Descripción de la vacante

San Juan Regional Medical Center is seeking an Utilization Management Assistant to support the UM team with denials, authorizations, and payor communications. This role requires attention to detail, strong communication, and the ability to work with EMR and billing systems.

The position emphasizes high-quality customer service, coordination with payors, and collaboration across the care team to mitigate denials and ensure timely processing. Training and growth opportunities are available.

Formación

• High School diploma or equivalent.
• 5 years’ experience in healthcare and/or insurance.
• Strong communication and customer service skills.
• Excellent phone etiquette and ability to work autonomously.
• Experience with Excel and Microsoft Office; knowledge of billing.

Responsabilidades

• Receives clinical denials via phone, fax and EMR.
• Documents inpatient authorizations and payor communications.
• Provides initial and concurrent clinicals to payors through EMR and payor portals.
• Maintains denial and appeal work queues for the UM team.
• Reviews and compiles denial and appeal documentation and submits promptly.
• Tracks concurrent and retrospective denials; coordinates peer‑to‑peer conversations.

Conocimientos

Strong communication

Customer service

Phone etiquette

Autonomous work

Prioritization

Insurance knowledge

Billing knowledge

Microsoft Excel

Microsoft Office

Educación

High School diploma or equivalent

Herramientas

Excel

Microsoft Office

Descripción del empleo

San Juan Regional Medical Center is seeking an Utilization Management Assistant to support the UM team with denials, authorizations, and payor communications. This role requires attention to detail, strong communication, and the ability to work with EMR and billing systems.

The position emphasizes high-quality customer service, coordination with payors, and collaboration across the care team to mitigate denials and ensure timely processing. Training and growth opportunities are available.