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BusinessOperations - Denial Specialist II - J00915

Mindlance

Remote-NC, NC(remote)

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JOB DETAILS
SKILLS
Background Investigation, Communication Skills, Data Analysis, Data Collection, Detail Oriented, Diversity, Documentation, Documentation Review, Electronic Medical Records, Establish Priorities, Healthcare Software, Maintain Compliance, Medical Records, Medical Terminology, Microsoft Excel, Microsoft Outlook, Microsoft Product Family, Microsoft Word, Multitasking, Patient Care Denials, Performance Metrics, Process Management, Productivity Management, Regulations, Secondary School, Time Management, Typing
LOCATION
Remote-NC, NC(remote)
POSTED
23 days ago
Position Purpose:
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

EEO:

Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.

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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 Saturday and Sunday 10:00-7:00 PM Monday, Thursday and Friday 1:00-10:00 PM Off Tuesday and Wednesday with 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 policies

Prioritize 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 hour

Remote 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 calls

Applications 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% accuracy

Computer literacy test Agency please attach with resume

Applications 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.)?

About the Company

M

Mindlance