PHRN Clinical Denials and Appeals

**Clinical Denials and Appeals Nurse** **Summary:** Review medical necessity and authorization denials, conduct comprehensive reviews of claim denials, and write appeal letters to payers using clinical indicators and documentation from patient medical records. **Responsibilities:** Review inpatient and/or outpatient medical necessity and authorization...

Make your next big career move by applying as KMC Solutions' next PHRN CLINICAL DENIALS AND APPEALS NURSE (PHRN)The main responsibilities of a PHRN CLINICAL DENIALS AND APPEALS NURSE (PHRN) include:Effectively review inpatient and/or outpatient medical necessity and authorization denials to determine and understand the validity of such denials in a timely...

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...

Nezda Global PH is seeking USRN and PHRN for its BPO partner in Pasig City Position: USRN and PHRNLocation: Bank Plaza, Meralco Avenue, cor Onyx and Sapphire St. Ortigas, Pasig CityWork Set-Up: Onsite and Night ShiftStart Date: October 2024 Qualifications:✓ USRN or PHRN with a minimum of 2 years of clinical nursing or case management experience✓ At least...

Job Title: Clinical Nurse Appeals WriterJob Summary:We are seeking a skilled Clinical Nurse Appeals Writer to join our team at Dencom Consultancy. As a key member of our appeals team, you will be responsible for writing high-quality appeals for denied claims, utilizing your expertise in MCG/InterQual criteria.Key Responsibilities:Develop and write...

Job Title: Clinical Nurse Appeals WriterWe are seeking a skilled Clinical Nurse Appeals Writer to join our team at Dencom Consultancy.Key Responsibilities:Developing and writing high-quality appeals for denied claimsCollaborating with clinical teams to ensure accurate and effective appealsStaying up-to-date with MCG/InterQual criteria and industry...

Job RequirementsWe are seeking a skilled Clinical Nurse Appeals Writer to join our team at Dencom Consultancy.Key Responsibilities:Collaborate with healthcare professionals to develop effective appeals strategies.Write compelling appeals documents that showcase clinical expertise and knowledge of MCG/InterQual criteria.Work closely with onsite teams to...

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...

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...

Seeking a Clinical Trainer to deliver training programs within Access Healthcare's Utilization Management account, enhancing team skills and knowledge in Utilization Management, Clinical Denials, and Appeals. The ideal candidate will possess a strong background in Utilization Management, Clinical Denials, and Appeals, with a focus on high-quality service...

Seeking a detail-oriented and organized professional to manage UMR and pre-auth processes, with a strong understanding of medical necessity guidelines and denials. **Job Summary:** We are looking for a skilled PHRN or USRN to join our team, with a strong background in clinical experience and knowledge of UMR and pre-auth processes. ...

Job Summary: The Appeal Writer reviews denied insurance claims, creates appeal letters, and manages workflow to support claim payment. The Appeal Writer plays a crucial role in supporting our client hospitals by reviewing denied insurance claims and creating appeal letters to secure payment. This position requires strong writing skills, attention to detail,...

MUST BE PHRN 2 yrs w/o clinical experienceMinimum 1 yr UMR and or pre auth experience with knowledge of denials and medical necessity guidelines-1 yr w/ clinical experience (bedside Medical Surgical, ER or OR)-1yr BPO w/ clinical experience or 2yrs BPO w/o clinical experience Offer :PHRN UMR- up to 50k package Temp WFH USRN UMR - up to 75k ( onsite )

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:-...

Registered Nurse needed to ensure completion of patient cases by conducting roll calls, processing clinical reviews, and authorizing surgeries. Key Responsibilities: Perform advanced clinical denial and utilization management work. Manage medical denials through comprehensive review of clinical documentation. Handle audit and...

Medical Biller role requires processing claims for pediatrics clinics in USA, ensuring timely payment, denial investigation, and A/R recovery. Responsibilities: Posting payments and downloading ERA/EOB Investigating and appealing denied claims, correcting and resubmitting as needed Performing A/R recovery and collection Verifying patient...

Access Healthcare is looking for experienced Inpatient/Outpatient Medical Coders to join our healthcare BPO 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...

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...