Denial Coordinator at LSMA Management Inc – san bernardino, California

JOB SUMMARY

The Denial Coordinator serves as a key liaison between patients, providers, health plans, and internal clinical leadership regarding utilization management denial and carve-out notifications in accordance with regulatory, health plan, CMS, and organizational standards. The Denial Coordinator ensures compliance, confidentiality, and effective communication while supporting audits, resolving inquiries, and promoting patient-centered service.

MINIMUM & PREFERRED QUALIFICATIONS

Education/Training

Minimum: High school diploma or equivalent.

Preferred: Coursework or training in healthcare administration, utilization management, or medical billing/coding.

Experience

Minimum: 2+ years of medical office or healthcare administrative experience.

Preferred: 1+ years of Utilization Management experience.

Any combination of educational and work experience that would be equivalent to the stated minimum requirements would qualify for consideration of this position.

Certification(s)

Typing certificate demonstrating a minimum of 45 WPM

Skills, Knowledge & Abilities

· Knowledge of medical terminology and healthcare administrative processes.

· Working knowledge of CPT, HCPCS, and ICD-10 coding.

· Strong written and verbal communication skills.

· Ability to interpret benefit coverage and utilization management determinations.

· High attention to detail with strong proofreading and documentation accuracy.

· Ability to organize, prioritize, and manage multiple deadlines in a fast-paced environment.

· Proficiency with general computer applications and electronic health record systems.

· Ability to exercise sound judgment and make independent decisions within established guidelines.

· Demonstrated professionalism, dependability, and service-oriented mindset.

· Effective problem-solving and conflict-resolution skills.

· Ability to work collaboratively and maintain positive interdepartmental relationships.

PHYSICAL, MENTAL & ENVIRONMENTAL REQUIREMENTS

The physical, mental, and environmental demands described here are representative of those required to successfully perform the essential functions of this job. This position requires the ability to perform work primarily in a seated, office-based environment with frequent use of computers, phones, and other standard office equipment. The role involves occasional standing, walking, and light lifting (up to 20 pounds), as well as routine bending, reaching, and repetitive hand use for typing and documentation. The position also requires sustained concentration, attention to detail, effective time management, and the ability to exercise sound judgment while handling sensitive and confidential information. Work is performed in a medical or administrative office setting with minimal exposure to environmental hazards.