We are seeking an adaptable, detail-oriented Denial Specialist to join a high-volume healthcare operations team in a fully remote capacity. In this critical role, you will generate, process, and maintain compliant provider and member correspondence for preservice and concurrent medical reviews. Working independently in a fast-paced virtual environment, you will translate Medical Director review documentation into formal approval and denial letters while adhering strictly to regulatory standards and production metrics.
Location: 100% Remote (Open to any US time zone)
Position Type: Full-Time Contract (12-Month Initial Contract with Potential for Perm Conversion)
Schedule: Thursday, Friday, & Monday (1:00 PM – 10:00 PM EST); Saturday & Sunday (10:00 AM – 6:30 PM EST); Rotating Holidays Required
Assessment Requirements: Typing Test (60+ WPM with 95%+ accuracy) & Computer Literacy Assessment
Key Responsibilities
- Correspondence Generation: Review Medical Director clinical determinations to draft, process, and issue accurate denial and approval letters for members and providers.
- Prioritization & Compliance: Monitor work queues, pending denial letters, escalations, and strict regulatory deadlines to ensure 100% compliance with turnaround times.
- High-Volume Output: Maintain robust productivity expectations once fully trained, including issuing a minimum of 4 denial letters per hour and/or 6–7 approval letters per hour.
- Process Tracking & Information Review: Stay updated on changing policy guidelines, payer updates, and internal operational shifts affecting denial handling.
- Virtual Operations: Manage workload, daily schedule, and administrative tracking independently without direct in-office supervision.
Qualifications & Core Capabilities
- Education & Experience: Prior experience in healthcare operations, medical denials, authorization processing, or regulatory correspondence management.
- Technical Proficiency: Advanced skills using Microsoft Office Suite (Excel, Outlook, Word, Teams, and OneNote).
- Key Skills Stack:
- Multi-tasking & Time Management: Ability to manage competing administrative tasks and high case volume efficiently.
- Adaptability: Thrives in a dynamic environment with changing regulations and operational updates.
- High Attention to Detail: Flawless document accuracy, strong proofreading skills, and precise data entry capabilities.
- System Requirements: Must pass a 60+ WPM / 95% accuracy typing test and a standard computer literacy assessment prior to submission.
