Denial Resolution Specialist
hace 2 semanas
About Us: At Third Way Health, we empower medical practices and healthcare organizations to deliver exceptional patient experiences while minimizing administrative burdens. Our innovative technology platform and world-class services enable practices to focus on what matters most: patient care.
Position Overview: We are seeking a skilled Denial Coordinator to join our team in the Medellin area. As a key member of our team, you will play a vital role in enhancing the healthcare experience for thousands of patients and providers in the US.
Responsibilities:
- Review and process daily assigned deferrals or denials, including decisions to deny, modify, or carve out cases.
- Monitor daily failed fax reports related to denials and deferrals, ensuring that letters and notifications are refaxed and properly documented in the referral system.
- Respond to provider or interdepartmental emails, documenting all communications in referral notes.
- Offer phone support for manual processes, addressing any issues or questions that may arise during operations.
- Follow internal policies and procedures diligently to maintain operational efficiency and uphold quality standards within the team.
- Undertake any other job-related responsibilities as assigned to support team objectives and contribute to overall operational success.
- Accurately log cases in software platforms to track and manage healthcare processes, AYCE and EZCAP, as necessary to ensure effective case handling and documentation.
Required Skills and Qualifications:
- University or associate degree
- Required knowledge in health insurance (at least 8 months)
- Strong communication, both written and verbal (candidates must be fluent in English and Spanish, C1 or above preferred)
- Expertise in healthcare (US healthcare sector experience; does not need to be a nurse or doctor) and managing call center operations
- Great active listening skills
- A patient and empathetic attitude
- Strong time management and organizational skills
- Adaptability and flexibility
- Comfortable working in fast-paced environments
- Excellent troubleshooting skills
- Computer literacy and proven track record of working in multiple systems in parallel
- Phone skills, including familiarity with complex or multi-line phone systems
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