Denial Specialist

BCforward is currently seeking a highly motivated Denial Specialist for an opportunity in Remote!

Position Title: Denial Specialist

Location: Remote

Anticipated Start Date: ASAP

Please note this is the target date and it is subject to change. BCforward will send official notice ahead of a confirmed start date.

Expected Duration: 6+ months of contract with possible extension

Job Type: [FULL TIME (>%3D30 HRS WEEKLY], [CONTRACT], [Remote]

Pay Range: $20.00 - $22.47/hr.

Please note that actual compensation may vary within this range due to factors such as location, experience, and job responsibilities, and does not encompass additional non-standard compensation (e.g., benefits, paid time off, per diem, etc.).

Requirements:

• Need to complete Typing test - less concerned about the speed, just need accuracy and punctuation (90% and up) and computer literacy skills test prior to submittal.
• Requires 1 - 2 years of related experience (basic knowledge of medical terminology), denials.
• Knowledge of denials process including understanding medical record information.

Job Description:

Shift Timings: Monday - Friday, 1pm-10pm CST or 11am-8pm PST

Note: Need to complete Typing test - less concerned about the speed, just need accuracy and punctuation (90% and up) and computer literacy skills test prior to submittal.

Position Purpose:

Generates, processes and maintains provider and member correspondence for preservice and concurrent review.

Required Education/Experience:

Requires a High School diploma or GED

Requires 1 - 2 years of related experience (basic knowledge of medical terminology), CNA, CMA, denials.

Knowledge of denials process including understanding medical record information.

Experiencing generating, mailing, and/or electronically faxing approval and/or denial letters to members and/or healthcare providers.

Ability to simplify complex information into clear, easy-to-understand language that meets specific reading grade-level requirements.

Strong attention to detail with a focus on accuracy and compliance.

Experience working in production-driven environments, meeting deadlines and performance metrics.

Skilled in Microsoft Office applications, including Word, OneNote, and Excel.

Responsibilities:

Create letters based on authorization outcomes (approved or denied) for Ambetter products.

Review letters for grammar, clarity, and compliance before sending.

Follow internal SOPs to minimize errors and maintain high quality scores.

Coordinate with authorization teams and clinical reviewers for clarification on decisions.

Monitor work queues and prioritize letters based on turnaround time requirements.

Verify that letters meet state, federal, and Ambetter-specific regulatory requirements.

We are driven by meeting turnaround time requirements and our production-driven environments.

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.

Benefits:

BCforward offers all eligible employees a comprehensive benefits package including, but not limited to major medical, HSA, dental, vision, employer-provided group life, voluntary life insurance, short-term disability, long-term disability, and 401k.

Keywords:

[Need to complete Typing test - less concerned about the speed, just need accuracy and punctuation (90% and up) and computer literacy skills test prior to submittal. Requires 1 - 2 years of related experience (basic knowledge of medical terminology), denials. Knowledge of denials process including understanding medical record information]

About BCforward:

Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward's 6,000 consultants support more than 225 clients globally.

BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BCforward to become a market leader and best in class place to work.

BCforward is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability.

To learn more about how BCforward collects and uses personal information as part of the recruiting process, view our Privacy Notice and CCPA Addendum. As part of the recruitment process, we may ask you to disclose and provide us with various categories of personal information, including identifiers, professional information, commercial information, education information, and other related information. BCforward will only use this information to complete the recruitment process.

This posting is not an offer of employment. All applicants applying for positions in the United States must be legally authorized to work in the United States. The submission of intentionally false or fraudulent information in response to this posting may render the applicant ineligible for the position. Any subsequent offer of employment will be considered employment at will regardless of the anticipated assignment duration.

Interested candidates please send resume in Word format Please reference job code 249604 when responding to this ad.