Hiring for PHRN | Denials Management Specialist | Competitive Salary Package

2 weeks ago

Metro Manila, Philippines Access Healthcare Services Manila, Inc. Full time

Accesshealthcare is looking for REGISTERED NURSE to join our growing team.

You'll be ensuring the completion of assigned patient cases by doing roll calls, processing concurrent and retro clinical reviews, work processing surgery authorizations, as needed.

Qualifications :

Must be Registered Nurse with Active licenseHospital Bedside experience (OR /
ER / ICU/ PACU / General Wards / After Surgery Care )Experience in BPO Healthcare account is a must (Denials Management)Must be amenable to work onsite at McKinley, TaguigCan start ASAP

Responsibilities :

Review and rectify errors in third party payer reimbursement denials based on documentation, billing accuracy, medical necessity, coding, modifier, and other related issues.Examine denied insurance claims to determine the reasons for denial and develop action plans to address and resolve issues.Prepare and submit appeals to insurance companies, including the necessary documentation and detailed explanations to support the claim.Maintain accurate records of all denial and appeal activities, including outcomes and correspondence with payers.Collaborate with healthcare providers, billing teams, and insurance companies to resolve discrepancies and obtain additional information as needed.Stay up-to-date with payer policies, regulations, and changes in healthcare billing practices to ensure compliance and minimize claim denials.Track and report on denial and appeal metrics, identifying trends and areas for improvement to enhance the denials management process.
Provide training and guidance to staff on best practices for denial prevention and resolution.

 

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