Denial Specialist II

Role Overview We are seeking an independent and highly detail-oriented Remote Correspondence Specialist to manage provider and member communications for preservice and concurrent reviews. In this virtual role, you will combine technical expertise, compliance knowledge, and communication skills to manage your time and productivity effectively without in-office oversight. Key Responsibilities Manage Correspondence: Generate, process, and maintain accurate provider and member correspondence based on Medical Director review documentation. Ensure Compliance: Execute all correspondence tasks in a timely manner to maintain strict adherence to regulatory standards and internal policies. Prioritize Workflow: Systematically review and manage pending denial letters, urgent escalations, and time-sensitive compliance deadlines. Monitor Updates: Consistently monitor internal communications, emails, and payer updates for policy changes that impact denial and approval handling. Meet Productivity Standards: Achieve established performance metrics post-training, which includes processing a minimum of 4 denial letters per hour and/or 6-7 approval letters per hour. Required Qualifications & Experience Experience: Minimum 1 year of experience working with healthcare denial management systems, including claims processing, correspondence platforms, and appeals tracking. Technical Proficiency: Highly proficient in the Microsoft Office Suite (Excel, Word, Outlook, Teams, and OneNote). Work Environment: Proven ability to thrive in a fully remote setting with minimal supervision while meeting strict productivity quotas. Core Competencies Multitasking: Ability to seamlessly juggle multiple systems, queues, and priorities in a fast-paced healthcare environment. Adaptability: Comfortably navigates rapidly changing policies, regulatory updates, and payer requirements. Attention to Detail: Ensures flawless accuracy in medical documentation, compliance tracking, and correspondence generation.

salary: $22.99 - $23 per hour
shift: First
work hours: 8 AM - 7 PM
education: High School

Responsibilities

Manage Correspondence: Generate, process, and maintain accurate provider and member correspondence based on Medical Director review documentation.
Ensure Compliance: Execute all correspondence tasks in a timely manner to maintain strict adherence to regulatory standards and internal policies.
Prioritize Workflow: Systematically review and manage pending denial letters, urgent escalations, and time-sensitive compliance deadlines.
Monitor Updates: Consistently monitor internal communications, emails, and payer updates for policy changes that impact denial and approval handling.
Meet Productivity Standards: Achieve established performance metrics post-training, which includes processing a minimum of 4 denial letters per hour and/or 6-7 approval letters per hour.

Skills

• Multi-tasking
• Adapt to change
• Attention to detail

Qualifications

• Years of experience: 1 year
• Experience level: Experienced

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Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact View email address on randstadusa.com.

Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).

This posting is open for thirty (30) days.

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.