Job Description
Job Description - Denial Specialist IIPosition Purpose The Denial Specialist II is responsible for generating, processing, and maintaining provider and member correspondence for preservice and concurrent review. This role ensures compliance with regulatory standards and supports denial management systems through accurate documentation, appeals tracking, and timely communication. Key Responsibiliti
7:30 AM
Log in and pull the overnight denial queue. Your worklist shows 40–80 claims flagged by the payer in the last 24 hours. Sort by do…
8:00 AM
Start working the queue. For each denial, you're reading the remittance advice, identifying the denial reason code (CO-4, CO-50, C…
9:30 AM
Hit a complex medical necessity denial from a Medicare Advantage plan. Open the patient chart, pull the clinical documentation, an…
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