Denial Specialist II - J00915

TEKsystems•Dallas, TX

8d•$22 - $22•Remote

About The Position

Remote – candidates can reside in PST, MST, CST BUT MUST WORK HOURS LISTED IN DAILY SCHEDULE Hours: -1-10pm Monday-Friday CST/ 8-5pm Monday-Friday CST/ 8-5pm Sunday-Thursday CST/ 1-10pm Sunday-Thursday CST/ 1-10pm Tuesday-Saturday CST/ 8-5pm Tuesday-Saturday CST Generate Approval and Denial Letters 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. Purpose: Additional staff due to influx for the Ambetter business Collaborative and supportive: We value open communication and knowledge sharing Professional growth: We promote skill development through training and continuous learning Positive morale: Regular team huddles and recognition programs help maintain engagement and motivation. Position Purpose: Generates processes and maintains provider and member correspondence for preservice and concurrent review. 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

Nice To Haves

Knowledge of denials process including understanding medical record information preferred.

Responsibilities

Generate Approval and Denial Letters
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.
Generates processes and maintains provider and member correspondence for preservice and concurrent review.
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