Job Details

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 includingunderstanding 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 templatesbased 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

EEO:

"Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of - Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans."

Story Behind the Need

• What is the purpose of this team?
• Describe the surrounding team (team culture, work environment, etc.) & key projects.
• Do you have any additional upcoming hiring needs, or is this request part of a larger hiring initiative?

• Purpose: Additional staff due to influx for the Ambetter business

• Collaborative and supportive: We value open communication and knowledge sharing
• Professional growth: We promote skill development through training and continuous learning
• Positive morale: Regular team huddles and recognition programs help maintain engagement and motivation.

Typical Day in the Role

• Walk me through the day-to-day responsibilities and a description of the project (Outside of the Workday JD).
• What are performance expectations/metrics?
• What makes this role unique?

Generate Approval and Denial Letters

• Create letters based on authorization outcomes (approved or denied) for Ambetter products.

Quality Assurance

• Review letters for grammar, clarity, and compliance before sending.
• Follow internal SOPs to minimize errors and maintain high quality scores.

Collaboration

• Coordinate with authorization teams and clinical reviewers for clarification on decisions.

Timely Processing

• Monitor work queues and prioritize letters based on turnaround time requirements.

Compliance and Accuracy

• Verify that letters meet state, federal, and Ambetter-specific regulatory requirements.

Performance Expectations:
We are driven by meeting turnaround time requirements and our production-driven environments. Candidate Requirements Education/Certification Required: High school diploma/GED Preferred: N/ Licensure Required: N/ Preferred: N/ Years of experience required: 1-2 years related experience (basic knowledge of medical terminology), CNA, CMA, denials.
Previous denial, appeals, UM experience a major plus

Disqualifiers: ****Please ensure candidates are literate in written and spoken English,
Limited technical proficiency
Limited attention to detail
Limited written communication skills
Not looking for someone that ONLY has call center experience.

dditional qualities to look for:

• Experiencing generating, mailing, and/or electronically faxing approval and/or denial letters to members and/or healthcare providers
• bility to simplify complex information into clear, easy-to-understand language that meets specific reading grade-level requirements.
• Strong attention to detail with a focus on accuracy and compliance.
• Experience working in production-driven environments, meeting deadlines and performance metrics.
• Skilled in Microsoft Office applications, including Word, OneNote, and Excel.

• Top 3 must-have hard skills stack-ranked by importance

1 Strong written and verbal communication in English 2 ttention to detail/compliance accuracy/independent work 3 Proficiency in Microsoft Office Suite Candidate Review & Selection

• Shortlisting process
• Candidate review & selection
• Interview information
• Onboard process and expectations

Projected Manager Candidate Review Date: 1-2 days post shortlisting
Type of Interviews:
Teams CAMERA ON Required Testing or Assessment (by Vendor): gencies please perform computer literacy test
***attach as separate document

pplications worked in most Excel, word, outlook, teams, one drive, one note

Typing test - less concerned about the speed, just need accuracy and punctuation (95% and up)