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PHRN Clinical Denials and Appeals

2 months ago

Manila, National Capital Region, Philippines AGS health Full time

Qualifications

At 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 validity of such denials in a timely mannerShould conduct comprehensive reviews of the claim denial and account, to make determinations of what action to be taken to obtain reimbursementUtilize payer policies, MCG and InterQual criteria to determine if account meets criteria for appealShould write an appeal letter to payer using appropriate clinical indicators, citing Official Coding Guidelines, and documentation from within the patient's medical recordPerform all other necessary steps on the specified accounts per Clients SOP's including documentation in the EMR, including appeal package creationManage 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 PartiesReporting 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 trainingWhat We OfferExcellent Company CultureDay 1 Health Insurance, plus free dependentFixed schedule and fixed weekends offNon-Toxic | Blended Non-Voice AccountEmployee Referral IncentiveOpportunity for promotionAbout UsWe are an analytics-driven, technology-enabled revenue cycle management company that alleviates financial and administrative burdens on healthcare providers by providing billing, coding, automation and analytics services.