Denial Specialist II

Immediate need for a Denial Specialist II. This is a 06-month contract opportunity with long-term potential and is located in U.S(Remote). Please review the job description below and contact me ASAP if you are interested.
 
Job Diva ID: 26-07567
 
Pay Range: $22 - $23/hour (negotiable based on experience).  Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:

• 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
• The team works from queues where tasks are either assigned to or pulled by the team member.
• The letters are created using a template. MD rationales will be reviewed, and easily readable descriptions are added, when necessary, for NCQA compliance.
• The quality goal is 95% or greater each month and the production is weighted by type of letter. A weekly and monthly average of 100% meets the goal.
• Assists with the compliance and turn-around time (TAT) log for all correspondence notifications.
• Independent work, flexible, prioritize deadlines (must action on denials as soon as it’s presented).
• Performance expectations/metrics – 4 letters completed per hour.
• Write and send correspondence letters to providers and members (in easily readable language), ensuring that they are sent within the contractual turnaround time.

Key Requirements and Technology Experience: 

• Key skills; - Health care industry experience, strong knowledge of medical terminology, strong writing and communication skills, Complies with all policies and standards, data entry within Excel.
• Knowledge of denials/approvals process (depending on the role listed) including understanding medical record information preferred.
• Strong knowledge of medical terminology.-
• Strong written communication skills and strong computer skills with ability to navigate quickly (data entry/Trucare/excel)
• Requires a High School diploma or GED.

 
Our client is a leading Healthcare Insurance Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

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