Denial Specialist II

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

Position Title: Denial Specialist II

Location: Remote, FL (Must reside in Florida)

Anticipated Start Date: ASAP

Expected Duration: 06 Months of contract with possible extension

Job Type: [FULL TIME (>%3D40 HRS WEEKLY], [CONTRACT], [Remote]

Schedule: 10:00 AM - 7:00 PM EST or 11:00 AM - 8:00 PM EST, including a weekend day. Option for a 10-hour shift on weekends. Training will be Monday through Friday, 9:00 AM - 6:00 PM EST or 10:00 AM - 7:00 PM EST.

Pay Range: $19.00/hr.

Job Summary:

We are seeking a highly motivated Correspondence Specialist to join our Sunshine Health Plan team, working remotely in Florida. This new role is essential for ensuring compliance with health plan guidelines and timely communication with members and providers. The role involves handling adverse notification correspondence, collaborating with various teams, and ensuring all tasks are completed accurately within required timeframes.

Key Responsibilities:

• Process and manage correspondence according to state and NCQA guidelines.
• Write and send letters to members and providers regarding adverse notifications.
• Act as a liaison between medical directors, care managers, and providers.
• Triage tasks, including communication management for various teams.
• Meet daily performance indicators, including 19-23 letters and 40-60 tasks per day.
• Participate in team meetings and monthly 1:1 sessions with supervisors.
• Maintain communication with management via email and instant messenger.

Qualifications:

Required:

• High school diploma/ Bachelor's Degree.
• 2+ years of experience in medical processing or a doctor's office setting.
• Strong clerical skills, with attention to detail and ability to multitask.

• Experience with systems like Trucare and Amisys.
• Previous experience in health plan compliance or administrative roles.

Skills and Competencies:

• Multitasking: Ability to manage multiple tasks efficiently.
• Problem-Solving: Proactive in identifying issues and providing solutions.
• Computer Savvy: Comfortable navigating various software systems and tools.

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 FOR SEO OPTIMIZATION]

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 for 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 237501 when responding to this ad.