Registered Nurse for Healthcare BPO| Utilization Review | PHRN(Non-Voice|Taguig)

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  (Insurance, Denials & Appeals, Coding, Utilization Review, Prior Authorization)Must be amenable to work onsite at McKinley, TaguigCan start ASAP
 

Responsibilities :

 

Perform advanced level work related to clinical denial and utilization management.Manage medical denials by conducting a comprehensive review of clinical documentation.Handle audit/compliance responsibilities and other administrative duties as required.Write compelling arguments based on the clinical documentation and the medical policies of the payer and submit appeals in a timely manner.Resolve charge problems to ensure accurate and complete billing, and inform staff on proper billing, follow-up, and documentation practices.Review and rectify errors in third party payer reimbursement denials based on documentation, billing accuracy, medical necessity, coding, modifier, and other related issues.Actively manage, maintain, and communicate denial or appeal activity to appropriate stakeholders and report suspected or emerging trends related to payer denials to Revenue Cycle management.



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