BusinessOperations - Denial Specialist II - J00915
Position Purpose:
Generates, processes and maintains provider and member correspondence for preservice and concurrent review.
Education/Experience:
Requires a High School diploma or GED
Requires 1 – 2 years of related experience.
Knowledge of denials process including understanding medical record information preferred.
Generates correspondence from EMR documentation and ensures correspondence tasks are processed in a timely manner to ensure compliance according to regulatory standards and policies
Updates and maintains correspondence templates based on regulatory, and interdepartmental correspondence inquiries
Coordinates all data collection, analysis, and reporting activities that impact the denial process
Assists with the compliance and turn-around time (TAT) log for all correspondence notifications
Performs other duties as assigned
Complies with all policies and standards
EEO:
“Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of – Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.”
=============
Generates, processes and maintains provider and member correspondence for preservice and concurrent review.
Education/Experience:
Requires a High School diploma or GED
Requires 1 – 2 years of related experience.
Knowledge of denials process including understanding medical record information preferred.
Generates correspondence from EMR documentation and ensures correspondence tasks are processed in a timely manner to ensure compliance according to regulatory standards and policies
Updates and maintains correspondence templates based on regulatory, and interdepartmental correspondence inquiries
Coordinates all data collection, analysis, and reporting activities that impact the denial process
Assists with the compliance and turn-around time (TAT) log for all correspondence notifications
Performs other duties as assigned
Complies with all policies and standards
EEO:
“Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of – Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.”
=============
| Story Behind the Need | |||||
|
Generates, processes and maintains provider and member correspondence for preservice and concurrent review. Remote position Thursday, Friday, and Monday 10:00-7:00 pm PST Saturday and Sunday 8:30 -5:00 PM PST with rotating Holidays. N/A |
||||
| Typical Day in the Role | |||||
|
Generates correspondence from Medical Director review documentation and ensures correspondence tasks are processed in a timely manner to ensure compliance according to regulatory standards and policies Prioritize Tasks: Review pending denial letters, escalations, and compliance deadlines. Check Emails & Updates: Look for policy changes, payer updates, or internal communications that could affect denial handling. Once fully trained, at least 4 denial letters per hour and/or at least 6-7 approval letters per hour Remote specialists manage time and productivity without in-office oversight and combines technical expertise, compliance knowledge, and strong communication skills in a virtual setting. |
||||
| Candidate Requirements | |||||
| Education/Certification | Required: High school/ Medical Terminology | Preferred: Knowledge of denials process including understanding medical record information and medical terminology preferred | |||
| Licensure | Required: N/a | Preferred: | |||
| Years of experience required: 1 year Process healthcare denial management systems (claims, correspondence platform, appeals tracking). Disqualifiers: cannot work shift times or open to holiday coverage Additional qualities to look for: Typing test: 60 words per minute |
|||||
|
1 | Multi-tasking | |||
| 2 | Adapt to change well | ||||
| 3 | Attention to detail proficient in excel, outlook, word, teams, one note | ||||
| Candidate Review & Selection | |||||
|
Projected Manager Candidate Review Date: | ASAP | |||
| Type of Interviews: |
Teams CAMERA ON | ||||
| Required Testing or Assessment (by Vendor): | Typing test 60 wpm – 95% accuracy Computer literacy test – Agency please attach with resume Applications – excel, outlook, word, teams, one note |
||||
| Next Steps | |||||
|
|||||
|
|||||
|
|||||
|
|||||
