PHRN - Clinical Denials and Appeals

Gratitude Philippines

R$3.8-4.3K[Bulanan]
Di lokasi - Taguig1 - 3 Tahun PengalamanSarjana MudaSepenuh-masa
Kongsi

Keterangan Kerja

Penerangan


Work set up: Onsite Opportunity – MCK Taguig, Cyber Sigma Building

Work schedule :Weekdays Night Shift schedule, Fixed Weekends Off


  • Effectively review inpatient and/or outpatient medical necessity and authorization denials to determine and understand the validity of such denials in a timely manner --Should conduct comprehensive reviews of the claim denial and account, to make determinations of what action to be taken to obtain reimbursement.
  • Utilize payer policies, MCG and InterQual criteria to determine if account meets criteria for appeal
  • Should write an appeal letter to payer using appropriate clinical indicators, citing Official Coding Guidelines, and documentation from within the patient's medical record
  • Perform all other necessary steps on the specified accounts per Clients SOP’s including documentation in the EMR, including appeal package creation
  • Manage the accounts until payment is received, the account is written-off, transferred to patient-liability, or other adjudication / movement within the system that is appropriate and agreed upon by both Parties
  • Reporting quality results, tracking and trending of educational opportunities of the coding and CDI specialists, responding to client subject matter needs, and providing educational support and training

Syarat-syarat

  • PH Registered Nurse with experience in doing medical necessity appeals, lack of authorization appeals.(6 months needed)
  • Proficient in reading Explanation of Benefits (EOB) and investigating denial root causes.
  • Must be skilled in navigating various payer and provider portals.
  • Typing speed of at least 45 WPM.
  • Strong command of the English language, both spoken and written.
  • Willing to work night shifts to communicate with payers.
  • Familiarity with MCG and InterQual is a plus.
  • Must NOT hold a USRN license
MCG
Preview

Esther Afolabi

Senior Talent Acquisition ConsultantGratitude Philippines

Aktif dalam masa tiga hari

Tempat Bertugas

Taguig

Disiarkan pada 03 June 2025

Laporkan

Peringatan Keselamatan Bossjob

Jika jawatan memerlukan anda bekerja di luar negara, sila berhati-hati dan berhati-hati dengan penipuan.

Jika anda menemui majikan yang mempunyai tindakan berikut semasa pencarian kerja anda, sila laporkan segera

  • menahan ID anda,
  • menghendaki anda memberikan jaminan atau mengumpulkan sesuatu,
  • memaksa anda untuk melabur atau mengumpul dana,
  • mengumpul faedah haram,
  • atau situasi haram yang lain.