What are the responsibilities and job description for the Denial Specialist II position at Professional Management Enterprises?
Job Title: Denial Specialist II
Location: Remote
Hours:Tues thru Sat for 10-7p Central OR Sun thru Thurs for 10-7p Central
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
It is the policy of the Company to provide equal employment opportunities to all qualified individuals and to administer all aspects and conditions of employment without regard to the following:
• Race and associated traits, including hairstyle; Color, Age, Sex, Sexual orientation, Gender, Gender identity and gender expression; Religion, including dress and grooming practices; National origin, including language use restrictions; Pregnancy, childbirth, or breastfeeding; Marital or familial status; Genetic information, including family medical history; Physical or mental disability; Citizenship and/or immigration status
• Medical conditions, including cancer, AIDS/HIV, and occupational pneumoconiosis without respiratory impairment
• Denial of family or medical care leave
• Use of a guide or support animal
• Military or veteran status
• Political activities or affiliations
• Exercise of civil rights
• Domestic violence, assault, or stalking victim status
• GED certificate
• Arrest, expunged, or sealed records
• Application for or enrollment in Medi-Cal
• Status as a smoker or non-smoker
• Credit report or credit information
• Child or spousal support withholding
• Wage garnishment for consumer debt
• Relationship with someone with a disability
• Lawful conduct occurring during nonworking hours not on Company premises
• Any other protected class, in accordance with applicable federal, state, and local laws
Discriminatory, harassing, or retaliatory behavior is prohibited from coworkers, supervisors, managers, owners, and third parties, including clientele. The Company takes allegations of discrimination, harassment and retaliation very seriously and will promptly conduct an investigation when warranted. Equal employment opportunity includes, but is not limited to, employment, training, promotion, demotion, transfer, leaves of absence and termination.
Location: Remote
Hours:Tues thru Sat for 10-7p Central OR Sun thru Thurs for 10-7p Central
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
It is the policy of the Company to provide equal employment opportunities to all qualified individuals and to administer all aspects and conditions of employment without regard to the following:
• Race and associated traits, including hairstyle; Color, Age, Sex, Sexual orientation, Gender, Gender identity and gender expression; Religion, including dress and grooming practices; National origin, including language use restrictions; Pregnancy, childbirth, or breastfeeding; Marital or familial status; Genetic information, including family medical history; Physical or mental disability; Citizenship and/or immigration status
• Medical conditions, including cancer, AIDS/HIV, and occupational pneumoconiosis without respiratory impairment
• Denial of family or medical care leave
• Use of a guide or support animal
• Military or veteran status
• Political activities or affiliations
• Exercise of civil rights
• Domestic violence, assault, or stalking victim status
• GED certificate
• Arrest, expunged, or sealed records
• Application for or enrollment in Medi-Cal
• Status as a smoker or non-smoker
• Credit report or credit information
• Child or spousal support withholding
• Wage garnishment for consumer debt
• Relationship with someone with a disability
• Lawful conduct occurring during nonworking hours not on Company premises
• Any other protected class, in accordance with applicable federal, state, and local laws
Discriminatory, harassing, or retaliatory behavior is prohibited from coworkers, supervisors, managers, owners, and third parties, including clientele. The Company takes allegations of discrimination, harassment and retaliation very seriously and will promptly conduct an investigation when warranted. Equal employment opportunity includes, but is not limited to, employment, training, promotion, demotion, transfer, leaves of absence and termination.