Communication Specialist- Bakersfield 1.1

Universal Healthcare MSO•Bakersfield, CA

14h•$25 - $31•Onsite

About The Position

The UM Communication Specialist is a specialized administrative role responsible for drafting, translating, and issuing Utilization Management (UM) determination letters in accordance with state and federal regulations, health plan requirements, and internal policies. Reporting to UM leadership, this position ensures that all UM communications including approval, modification, denial, and request-for-information notices are accurate, timely, compliant, and written in clear, professional language. This role serves as the primary point of contact for UM written communications and requires bilingual fluency in English and Spanish, including bilingual certification. The UM Communication Specialist translates and prepares standardized and customized letters, ensuring accuracy in medical terminology, benefit descriptions, regulatory language, and member-friendly explanations. The position also supports UM operations by coordinating with clinical staff, validating key authorization data, and maintaining accurate templates and documentation. The UM Communication Specialist plays a crucial role in meeting Turn-Around Time (TAT) requirements and supporting the overall delivery of clear, compliant, and member-centered communication.

Requirements

High school diploma or equivalent required; associate’s degree preferred.
Bilingual certification required (English/Spanish); must demonstrate proficiency in written translation.
2–3 years of experience in a healthcare administrative, UM, medical billing, or medical office setting preferred.
Prior experience drafting professional correspondence; strong writing and editing skills required.
Knowledge of medical terminology, CPT/ICD/HCPCS codes, and managed care concepts (IPA, HMO, PPO) preferred.
General knowledge of EZ-CAP or similar authorization systems preferred.
Proficient in Microsoft Office applications, including Word, Excel, and Outlook.
Ability to create clear, accurate, and grammatically correct documents.
Strong attention to detail and ability to handle complex information with accuracy.
Ability to adapt to shifting priorities while meeting strict deadlines.
Excellent customer service and professional communication skills.
Ability to work independently and collaboratively within a team environment.
Reliable attendance and ability to adhere to organizational policies, procedures, and professionalism standards.

Responsibilities

Draft, translate, and issue UM determination letters (English and Spanish) including approvals, modifications, denials, requests for additional information, and other required member communication.
Ensure all letters meet CMS, DHCS, NCQA, health plan, and regulatory standards.
Translate clinical and administrative information into member-friendly language without altering meaning or compliance intent.
Maintain accuracy of medical terminology, CPT/ICD/HCPCS references, and benefit descriptions in all written materials.
Review letters for grammatical accuracy, clarity, consistency, and compliance prior to release.
Maintain, update, and audit all required letter templates for accuracy and version control.
Collaborate with clinical UM staff and Medical Directors to ensure determination details are accurately reflected in letters.
Validate member eligibility, benefits, provider contract status, and authorization details to ensure accuracy of determination letters.
Coordinate with UM Nurses and other internal departments to ensure timely receipt of clinical notes and decision summaries.
Process and log incoming requests, communications, or documents that relate to UM determinations.
Assist in mailing and distribution of all UM notifications and maintain proper documentation per regulatory requirements.
Monitor and meet TAT requirements for all written communications.
Respond professionally to inquiries from members, providers, health plans, and internal personnel related to UM letters or determinations.
Maintain up-to-date knowledge of regulatory guidance to ensure accuracy of all notices.
Work with Quality and Compliance teams during audits to provide samples and documentation related to UM letters.
Participate in UM and organizational quality improvement initiatives.
Support development of improved letter templates, workflows, and communications processes.
Assist with CMS notices, continuity of care communications, and other required correspondence with external agencies and facilities.
Maintain confidentiality and handle all PHI in compliance with HIPAA.
Perform other duties as assigned.