BusinessOperations – Denial Specialist II – J00915 Denial Specialist II – J00915 Position Available In [Unknown county], Louisiana

BusinessOperations

• Denial Specialist II
• J00915 Denial Specialist II
• J00915#25-61917
  Various, LA
  All On-site Job Description

Job Description:

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
Comments for

Vendors:

EEO:

“Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of

• Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.

” =====
Centene Job Description
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 Story Behind the Need

• Business Group & Key Projects Health plan or business unit
  Team culture
  Surrounding team & key projects
  Purpose of this team
  Reason for the request
  Motivators for this need
  Any additional upcoming hiring needs?

Replacing previous contractor Chatni Brown.
Business needs as work increases
Typical Day in the Role Daily schedule & OT expectations
Typical task breakdown and rhythm
Interaction level with team
Work environment description Review faxes and process them into electronic medical record system.
Fax denial letters.
Compelling Story & Candidate Value Proposition What makes this role interesting?
Points about team culture
Competitive market comparison
Unique selling points
Value added or experience gained Candidate Requirements
Education/Certification

Required:

High School diploma,

Preferred:

Licensure

Required:

Preferred:

Years of experience required
Disqualifiers
Best vs. average
Performance indicators Must haves: Medical term knowledge, customer service experience Nice to haves:

HCPS/CPT

coding

Disqualifiers:

Performance indicators: Complete 25-35 calls a day Best vs.

average:

Top 3 must-have hard skills
Level of experience with each
Stack-ranked by importance
Candidate Review & Selection 1 Computer skills
2 MS office/Teams
3 Candidate Review & Selection Shortlisting process
Second touchpoint for feedback
Interview Information

Onboard Process and Expectations Projected HM Candidate Review Date:

Number and Type of Interviews:

1
Extra Interview Prep for

Candidate:

No
Required Testing or Assessment (by Vendor): No
Manager Communication Preferences & Steps Background Check Requirements (List DFPS or other specialty checks here) No Do you have any upcoming PTO? No Colleagues to cc/delegate Tracy Green