Denial Specialist II

BC Forward is looking for Denial Specialist II - 100% Remote

Position: Denial Specialist II

Location: 100% Remote

Duration: 12 months of contract with extension and contract to hire

Shift: Sunday- Thursday 1pm - 10pm CST

Pay Rate: $23.00/hr

Required: Must pass a computer competency test and achieve 60 WPM typing speed with at least 90% accuracy.

Position Purpose:

The Denial Specialist is responsible for generating, processing, and maintaining provider and member correspondence for preservice and concurrent reviews. This includes ensuring correspondence is processed in a timely manner, compliant with regulatory standards and internal policies.

Key Responsibilities:

• Generate correspondence from EMR (electronic medical record) documentation, ensuring timely processing and compliance with regulatory and organizational standards.
• Update and maintain correspondence templates based on regulatory requirements and internal department inquiries.
• Coordinate all data collection, analysis, and reporting activities that impact the denial process.
• Assist with maintaining the compliance and turnaround time (TAT) log for all correspondence notifications.
• Perform other duties as assigned.
• Ensure compliance with all policies and standards.

Education/Experience Requirements:

• High school diploma or GED.
• 1-2 years of related experience preferred.
• Knowledge of the denials process and medical record information is a plus.

Skills Required:

• Computer skills, including proficiency with Microsoft Office and Teams.
• Customer service experience.
• Medical terminology knowledge.

Preferred Skills:

• HCPCS/CPT coding knowledge.

Additional Requirements:

• Typing speed of 60 words per minute (minimum).
• Must pass a computer competency test and a typing test with a 90% pass rate.
• Previous experience in customer service or medical office management is a plus.

Performance Metrics:

• Complete 25-35 phone calls daily.
• Fax denial letters to providers as required.

Interested candidates please send resume in Word format Please reference job code 248056 when responding to this ad.