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 GEDRequires 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 policiesUpdates and maintains correspondence templates based on regulatory, and interdepartmental correspondence inquiriesCoordinates all data collection, analysis, and reporting activities that impact the denial processAssists with the compliance and turn-around time (TAT) log for all correspondence notificationsPerforms other duties as assignedComplies with all policies and standardsEEO: 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
Story Behind the Need
What is the purpose of this team? Describe the surrounding team (team culture, work environment, etc.) & key projects. Do you have any additional upcoming hiring needs, or is this request part of a larger hiring initiative?		Generates, processes and maintains provider and member correspondence for preservice and concurrent review. Remote position Monday -Friday 10:00-7:00 PM PST 12:00-9:00 PM CSTwith rotating Holidays. N/A
Typical Day in the Role
Walk me through the day-to-day responsibilities and a description of the project (Outside of the Workday JD). What are performance expectations/metrics? What makes this role unique?		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 policiesPrioritize 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 hourRemote specialists manage time and productivity without in-office oversight and combines technical expertise, compliance knowledge, and strong communication skills in a virtual setting.No phone callsApplications Centene Trucare classic/cloud, Applications other Outlook, Teams, one note, excel, word, one drive
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). Knowledge of denials process including understanding medical record information and medical terminology, comfortable with Microsoft 360 suite and basic computer knowledge.Disqualifiers: cannot work shift times or open to holiday coverage, Job hopping (unless contract, please state if contract and if completed), Additional qualities to look for: Typing test: 60 words per minute
Top 3 must-have hard skills stack-ranked by importance		1	Multi-tasking, tech savvy, Time management
		2	Adapt to change well, independent work, troubleshooting
		3	Attention to detail proficient in excel, outlook, word, teams, one note
Candidate Review & Selection
Shortlisting process Candidate review & selection Interview information Onboard process and expectations		Projected Manager Candidate Review Date:			ASAP
		Type of Interviews:			Teams CAMERA ON
		Required Testing or Assessment (by Vendor):			Typing test 60 wpm 95% accuracyComputer literacy test Agency please attach with resumeApplications excel, outlook, word, teams, one note
Next Steps
Additional background check requirements (List DFPS or other specialty checks here)
Do you have any upcoming PTO?
Colleagues to cc/delegate
Are there any training requirements (time off, alternate schedule, etc.)?