Denial Specialist II

Denial Specialist II

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

Position Title: [Denial Specialist II]

Location: [Remote - FL]

Anticipated Start Date: [ASAP]

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

Expected Duration: [06 Months Contract]

Job Type: [FULL TIME (>%3D30 HRS WEEKLY)/PART TIME (<30 HRS WEEKLY)], [CONTRACT TO EXTENSION], [REMOTE]

Pay Range: [$17.00] - [$19.00]

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:

• 2 years of medical processing or doctor's office setting experience
• Knowledge of denials process.

Job Description:

Position Purpose:

The Denial Specialist II is responsible for generating, processing, and maintaining provider and member correspondence related to preservice and concurrent reviews. This role ensures timely and accurate communication aligned with regulatory standards and NCQA guidelines. The position also involves coordination of triage communications with care managers, providers, and medical directors.

Essential Responsibilities:

• Generate correspondence from EMR documentation and ensure timely processing.
• Maintain and update correspondence templates based on regulatory or internal inquiries.
• Track and support compliance with correspondence turnaround time (TAT) standards.
• Coordinate data collection, analysis, and reporting related to denial processes.
• Collaborate across departments to support efficient denial management.
• Participate in monthly 1:1s, team meetings, and maintain open communication with leadership.
• Perform other duties as assigned.
• Comply with all company policies, procedures, and standards.

Qualifications:

Education & Experience:

• Required: High school diploma or GED
• Preferred: Bachelor's Degree
• Experience: 1-2 years in a related role (e.g., medical processing, clerical roles in healthcare or doctor's office settings)

Skills:

• Strong multitasking and organizational abilities
• Proficient in computer systems and Microsoft Office Suite
• Excellent attention to detail and written communication skills
• Strong problem-solving and decision-making capabilities

Preferred Systems Experience (not required):

• TruCare, Amisys

Performance Expectations:

• 19-23 letters completed per day (correspondence)
• 40-60 tasks per day (triage)
• High accuracy with minimal errors
• Ability to meet deadlines and stay compliant with state and NCQA guidelines

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:

[KEYWORDS FOR SEO OPTIMIZATION]

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 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 237602 when responding to this ad.

---