Denial Resolution Specialist

hace 2 semanas


Medellín, Antioquia, Colombia Third Way Health, Inc. A tiempo completo

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:

  1. Review and process daily assigned deferrals or denials, including decisions to deny, modify, or carve out cases.
  2. Monitor daily failed fax reports related to denials and deferrals, ensuring that letters and notifications are refaxed and properly documented in the referral system.
  3. Respond to provider or interdepartmental emails, documenting all communications in referral notes.
  4. Offer phone support for manual processes, addressing any issues or questions that may arise during operations.
  5. Follow internal policies and procedures diligently to maintain operational efficiency and uphold quality standards within the team.
  6. Undertake any other job-related responsibilities as assigned to support team objectives and contribute to overall operational success.
  7. 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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