PHRN Clinical Denials and Appeals

Clinical Denials Clinician recovers revenue through intelligent investigation of disputed claims, verifying eligibility, and preparing appeals based on industry-accepted criteria. They synergize with the Denials team on processes and best practices. Responsibilities include serving as a resource, providing process improvements, and performing medical...

Recover revenue and drive process improvement as a Clinical Denials Clinician in a healthcare setting.Responsibilities include:Providing expertise to non-clinical personnel on clinical mattersCollaborating with leadership to develop and implement process improvementsAssisting in the development of policies and proceduresReviewing medical necessity cases and...

Job Requirements:- Possess a strong clinical background with at least 3 years of experience as a PHRN/USRN.- Proven track record of writing effective appeals for denied claims in the I/OP setting.- In-depth knowledge of MCG/InterQual criteria is essential for success in this role.Work Environment:- Willingness to work on-site and adapt to a night shift...

Key Requirements:- Possess at least 3 years of clinical experience as a PHRN/USRN.- Demonstrate strong appeals writing skills for denied claims (I/OP).- Possess in-depth knowledge of MCG/InterQual criteria.Working Conditions:- Willingness to work onsite and adapt to a night shift schedule.Interested in this role?Learn more about our company culture and apply...

Job Requirements:- A PHRN/USRN with at least 3 years of clinical experience is required for this role.- The ideal candidate will have solid appeals writing experience for denied claims (I/OP).- Knowledge of MCG/InterQual criteria is essential for success in this position.- The successful candidate will be willing to work onsite and on night shift...

Job DescriptionWe are seeking a Clinical Nurse Appeals Writer to join our team at Dencom Consultancy.About the RoleThis is a unique opportunity for a dedicated and experienced nurse to leverage their clinical expertise in appeals writing, working closely with our team to resolve denied claims.The ideal candidate will possess a strong understanding of...

Job Requirements:- 3+ years of clinical experience as a PHRN/USRN.Key Responsibilities:- Developing and writing appeals for denied claims (I/OP) with expertise in MCG/InterQual criteria.Essential Skills:- Willingness to work onsite and on a night shift schedule.How You'll Make a Difference:As a skilled nurse appeals writer, you will play a critical role in...

Job Title: Medical Appeals SpecialistWe are seeking a skilled Clinical Nurse Appeals Writer to join our team at Dencom Consultancy.About the Role:As a Clinical Nurse Appeals Writer, you will be responsible for writing appeals for denied claims. You must have at least 3 years of clinical experience and solid knowledge of MCG/InterQual criteria.Key...

We are seeking a Registered Nurse with active license, at least 1 year of hospital bedside experience, and strong communication skills. Key advantages: Denials and Appeals writing experienceHealthcare BPO experienceBenefits of joining us:HMO on day 1Annual salary appraisalNon-taxable allowance20% night differentialFree shuttle service

Key Responsibilities:- Collaborate with experienced clinical professionals to develop and implement effective appeals strategies for denied claims.- Utilize in-depth knowledge of MCG/InterQual criteria to craft compelling appeals that drive successful outcomes.- Work closely with the team to ensure seamless communication and efficient workflow.Requirements:-...

Job Title: Medical Prior Authorization SpecialistAt Med Supply US, we are seeking a highly skilled Medical Prior Authorization Specialist to join our team. As a key member of our healthcare team, you will play a crucial role in ensuring that medical services, procedures, and medications are approved by insurance companies or third-party payers before they...

**About ACCPRO International**We are a leading provider of exceptional healthcare services, dedicated to delivering high-quality patient care and fostering a dynamic work environment.**Competitive Salary Package**Our competitive salary package includes an estimated monthly salary range of PHP 50,000 - 70,000, commensurate with experience.**Job...

Clinical Pharmacist role at Commonwealth Hospital and Medical Center involves drug therapy assessment, patient counseling, profile patient review, and patient medication history.Responsibilities include:* Drug therapy assessment* Patient counseling* Profile patient review* Patient medication historyRequirements include:* Bachelor of Science in Pharmacy Major...

We are seeking a Clinical Pharmacist to join our team at CommonwealthMed, a Level 2 hospital with 140 authorized beds and a staff count of over 600 direct and outsourced staff. The successful candidate will be responsible for drug therapy assessment, patient counseling, and patient medication history.Responsibilities:Assess drug therapy and provide...

Job DescriptionWe are seeking a skilled Prior Authorization Specialist to join our team at Med Supply US. As a key member of our healthcare access team, you will play a crucial role in ensuring that medical services and procedures are approved by insurance companies.Key Responsibilities:Prior Authorization Management: Review medical service requests, gather...

Job Title: Medical Prior AuthorizationAbout the RoleAt Med Supply US, we are seeking a highly skilled Medical Prior Authorization Specialist to join our team. This role plays a crucial part in ensuring that medical services and procedures are approved by insurance companies before they are rendered.Key ResponsibilitiesPrior Authorization Management: Review...

Registered Nurse Wanted: 1+ yr hospital bedside experience with good communication skills. Benefits include HMO, annual salary appraisal, non-taxable allowance, and free shuttle service.

Job Title: Sales AssociateAt Right Personal and Home Care Products Trading, we are seeking a highly motivated and customer-focused Sales Associate to join our team.Key Responsibilities:Provide exceptional customer service, ensuring a positive experience for every customer interaction.Achieve sales goals by effectively promoting products and services to...

As a Content Creator at Rights Personal and Home Care Products, you will play a crucial role in crafting engaging and impactful content to support the company's marketing and brand initiatives. This full-time position is based in Metro Manila and offers the opportunity to be part of a dynamic and collaborative team, contributing to the growth and success of...

QualificationsAt least 1 year of relevant BPO experience as a Clinical Denials and Appeals NurseMinimum of 6 mos hospital experiencePHRN licenseWilling to report onsite (McKinley West, Taguig) and on a night shift scheduleResponsibilitiesEffectively review inpatient and/or outpatient medical necessity and authorization denials to determine and understand the...

Access Healthcare 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.Responsibilities :Perform advanced level work related to clinical denial and utilization...

SUMMARYThe Clinical Denials Clinician of AR Management is responsible for recovering revenue through a.) intelligent and ethical investigation of disputed/denied clinical claims, b.) verifying eligibility for clinical review, and c.) preparation and documentation of appeals based on industry-accepted criteria. He / She is also relied on when it comes to...

- PHRN/USRN with at least 3 years of clinical experience- Solid appeals writing experience for denied claims (I/OP)- Knowledge of MCG/InterQual criteria- Willingness to work onsite and on night shift schedule.Interested? APPLY NOW!Email your updated resume to athenaluna.dc@gmail.comThank you.

- PHRN/USRN with at least 3 years of clinical experience - Solid appeals writing experience for denied claims (I/OP) - Knowledge of MCG/InterQual criteria - Willingness to work onsite and on night shift schedule. Interested? APPLY NOW! Email your updated resume to athenaluna.dc@gmail.com Thank you.

- PHRN/USRN with at least 3 years of clinical experience - Solid appeals writing experience for denied claims (I/OP) - Knowledge of MCG/InterQual criteria - Willingness to work onsite and on night shift schedule. Interested? APPLY NOW! Email your updated resume to Thank you.

The Clinical Trainer will be responsible for delivering training programs within Access Healthcare's Utilization Management account. The ideal candidate must possess a strong background in Utilization Management, Clinical Denials, and Appeals, with a focus on enhancing the skills and knowledge of our team to ensure high-quality service delivery.Key...

Accesshealthcare is looking for REGISTERED NURSE to be part of our growing team!QualificationsMust be Registered Nurse with Active licenseAtleast 1 yr hospital bedside experienceExperience in Denials and Appeals writing is a definite advantageExperience in Healthcare BPO is a definite advantageGood communication skillsCan work onsite at McKinley, TaguigWhy...

Access Healthcare is looking for experienced Inpatient/Outpatient Medical Coders to join our PIONEER TEAM team. The ideal candidate will have at least 3 years of outpatient coding experience in one or more of the following specializations: Inpatient DRG, Clinical Documentation Specialist, Emergency Department (ED) Facility, Observation, Evaluation Management...

General ProfileUS REGISTERED NURSERequires knowledge and experience in the field.Will acquire higher-level knowledge and skills.Develops an understanding of the company, processes, and customers.Uses existing procedures to solve routine or standard problems.Receives moderate guidance and direction from others.Responsibility StatementsApplies medical judgment...

Medical Prior Authorization-Insurance Verification SpecialistPosition Summary:The Prior Authorization Specialist plays a crucial role in the healthcare industry by ensuring that medical services, procedures, and medications are approved by insurance companies or third-party payers before they are rendered or prescribed. They work closely with healthcare...

Shift Schedule: Nightshift - 8PM-5AMWork Setup: Onsite - McKinley, Taguig Overview:A Radiology Prior Authorization Specialist plays a key role in ensuring that patients receive the necessary medical services, procedures, and imaging tests by obtaining insurance approval. This specialist navigates complex payer requirements, ensuring compliance and accurate...

Since November 2021, Commonwealth Hospital and Medical Center has been owned mainly by Metro Pacific Health (MPH) network, a part of the MVP Group of companies. It is the 19th hospital to join Metro Pacific Health, which also includes Makati Medical Center, Asian Hospital, Cardinal Santos Medical Center, Manila Doctors Hospital, OLLH, De Los Santos Medical...

Manila PHRN - Insurance Voice 5 months Onsite Training then hybid set up after College Graduate 2 Years Clinical Experience 30,175 HMO Plus 3 Dependents, 22 Paid Leaves 13th Month Pay

Manila PHRN - Insurance Voice 5 months Onsite Training then hybid set up after College Graduate 2 Years Clinical Experience 30,175 HMO Plus 3 Dependents, 22 Paid Leaves 13th Month Pay

Graduate of NursingWith at least 1 year Clinical experience and can provide COE (Certificate of Employment)With active PRC licenseOnsite training 5-6 months and Hybrid-set up afterwards depending on performance and asset availabilityNight shift / Shifting SchedulesWeekends offSite: MOA Pasay,

Graduate of Nursing With at least 1 year Clinical experience and can provide COE (Certificate of Employment) With active PRC license Onsite training 5-6 months and Hybrid-set up afterwards depending on performance and asset availability Night shift / Shifting Schedules Weekends off Site: MOA Pasay,

Graduate of Nursing With at least 1 year Clinical experience and can provide COE (Certificate of Employment) With active PRC license Onsite training 5-6 months and Hybrid-set up afterwards depending on performance and asset availability Night shift / Shifting Schedules Weekends off Site: MOA Pasay,

Job Purpose The Medical Claims Representative is responsible for collections, account follow up, billing and allowance posting for the accounts assigned to them.Duties and Responsibilities Follow-up with payers to ensure timely resolution of all outstanding claims, via phone, emails, fax or websites. Meets and maintains daily productivity/quality...

CSR (VOICE)Calling out to those who are licensed Registered Nurse ! · PH Registered nurse· With active PRC license (valid for at least 6 months)· 1 year bedside / direct patient care experience required or as a company /clinic nurse with COE· Good verbal & written communication skills· Amenable to report Onsite·...