Denial Specialist II

Denial Specialist II - J00915 BC Forward is looking for Denial Specialist II (Remote EST/CST) Position Title: Denial Specialist II (Remote EST/CST) Location: Remote EST/CST Anticipated Start Date: 03/23 Duration: 12 months Job Type: Contract with extension/conversion to FTE Shift: Training includes a 3-week Learning Journey (8:00 AM-5:00 PM EST; hours may vary if start date differs), followed by 6 weeks of department-specific training on either 9:30 AM-6:30 PM EST or 10:00 AM-7:00 PM EST schedules, then a regular Monday-Friday shift of 1:00 PM-10:00 PM EST with rotating holidays and occasional weekends as needed. Pay Rate: $23/hour(W2) Need: Minimum 1+ year experience processing healthcare denial management systems, including claims, correspondence platforms, and appeals tracking. Interview Process: 1-Phone Screen, 2-VirtualJob Description: Denial Specialist II 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 the denials process, including understanding medical record information, preferred Key Responsibilities 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 turnaround time (TAT) log for all correspondence notifications Performs other duties as assigned Complies with all policies and standards Daily Schedule (OT Requirements) Training - Learning Journey 3-week course (3/16 and/or 4/6) from 8:00 AM - 5:00 PM EST If starting on a different date than aligned with the learning journey, hours may vary until training begins Department-Specific Training After the 3-week learning journey, candidates will complete 6 weeks of department-specific training Assigned trainer schedule: 9:30 AM - 6:30 PM EST or 10:00 AM - 7:00 PM EST Schedule After Training Monday-Friday: 1:00 PM - 10:00 PM EST Rotating holidays and some weekend coverage if needed Story Behind the Need Purpose of this Team Generates, processes, and maintains provider and member correspondence for preservice and concurrent review. Work Environment Remote position Monday-Friday, 1:00 PM - 10:00 PM EST Rotating holidays and occasional weekend coverage Additional Hiring Needs N/A Typical Day in the Role Day-to-Day Responsibilities Process denial management systems (claims, correspondence platform, appeals tracking) Prioritize tasks: review pending denial letters, escalations, and compliance deadlines Check emails and updates for policy changes, payer updates, or internal communications affecting denial handling Performance Expectations / Metrics Once fully trained: At least 4 denial letters per hour, and/or At least 6-7 approval letters per hour What Makes This Role Unique Remote specialists manage time and productivity without in-office oversight Combines technical expertise, compliance knowledge, and strong communication skills in a virtual setting Applications Required Excel Outlook Word Teams OneNote Candidate Requirements Education/Certification Required: High School / Medical Terminology Preferred: N/A Licensure Required: N/A Preferred: N/A Experience Minimum 1+ year processing healthcare denial management systems (claims, correspondence platform, appeals tracking) Disqualifiers Cannot work shift times or not open to holiday coverage Typing Requirement 60 words per minute Top 3 Must-Have Hard Skills (Ranked)Multitasking, tech-savvy Ability to adapt to change well Attention to detail; proficiency in Excel, Outlook, Word, Teams, and OneNote Candidate Review & Selection Projected Manager Candidate Review Date: ASAP Interview Type Microsoft Teams - Camera ON Required Testing or Assessments (by Vendor) Typing test: 60 WPM - 95% accuracy Computer literacy test - agency must attach with resume Applications: Excel, Outlook, Word, Teams, OneNote Interested candidates please send resume in Word format Please reference job code 250268 when responding to this ad.

Created: 2026-03-10