Denial Specialist

BCforward is currently seeking a highly motivated Denial Specialist for an opportunity in RemotePosition Title: Denial SpecialistLocation: RemoteAnticipated Start Date: ASAPPlease note this is the target date and it is subject to change. BCforward will send official notice ahead of a confirmed start date.Expected Duration: 6+ months of contract with possible extensionJob Type: [FULL TIME (>=30 HRS WEEKLY], [CONTRACT], [Remote]Pay Range: $20.00 - $22.47/hr.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: Need to complete Typing test - less concerned about the speed, just need accuracy and punctuation (90% and up) and computer literacy skills test prior to submittal. Requires 1 - 2 years of related experience (basic knowledge of medical terminology), denials. Knowledge of denials process including understanding medical record information.Job Description:Shift Timings: Monday - Friday, 1pm-10pm CST or 11am-8pm PSTNote: Need to complete Typing test - less concerned about the speed, just need accuracy and punctuation (90% and up) and computer literacy skills test prior to submittal.Position Purpose:Generates, processes and maintains provider and member correspondence for preservice and concurrent review.Required Education/Experience:Requires a High School diploma or GEDRequires 1 - 2 years of related experience (basic knowledge of medical terminology), CNA, CMA, denials.Knowledge of denials process including understanding medical record information.Experiencing generating, mailing, and/or electronically faxing approval and/or denial letters to members and/or healthcare providers.Ability to simplify complex information into clear, easy-to-understand language that meets specific reading grade-level requirements.Strong attention to detail with a focus on accuracy and compliance.Experience working in production-driven environments, meeting deadlines and performance metrics.Skilled in Microsoft Office applications, including Word, OneNote, and Excel.Responsibilities: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.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 plies with all policies and standards.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.[Need to complete Typing test

Created: 2026-02-05