Denials Management Analyst

This position is responsible for identifying, capturing, tracking, reviewing, and resolving held claim edits, claim rejections, and/or denials that result from the claims/billing cycle. This position ensures all resolutions utilized are in accordance with policies, procedures, official coding guidelines/advice, rules and regulations (payer, state, and/or...

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...

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...

Job PurposeThe Quality Analyst, Coding collaborates with internal staff in the development of improved capabilities in the areas of documentation, coding, and compliance. The Quality Analyst, Coding will assess and review the overall quality of coding on accounts completed by Medical Coders. The Quality Analyst, Coding, ensures adherence to workflows and...

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...

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...

Job Summary:The Revenue Cycle Management (RCM) Training Manager is responsible for designing, developing, and implementing comprehensive training programs to enhance the efficiency, knowledge, and skills of the revenue cycle team. This role ensures that all staff members are properly trained in revenue cycle management processes, including billing,...

Access Healthcare is looking for experienced 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: Emergency Department (ED) Facility, Observation, Evaluation Management (E/M), Denials and Appeals, and Same Day Surgery. This...

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...

Experienced Inpatient/Outpatient Medical Coders sought for a dynamic team. Access Healthcare is looking for experienced Inpatient/Outpatient Medical Coders to join our 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,...

Experienced Inpatient/Outpatient Medical Coders sought for a dynamic team. Access Healthcare is looking for experienced Inpatient/Outpatient Medical Coders to join our 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,...

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...

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:** Information Security Specialist responsible for protecting PPG from cyber threats, conducting risk assessments, and ensuring compliance with security policies. **Key Responsibilities:** Assist and coordinate activities to ensure accurate and timely delivery of results to users in accordance with acceptable practices and written...

Job Title: Supply Chain Management, Analyst, AssistantJob Description:We are seeking an experienced Supply Chain Management, Analyst, Assistant to join our team. CM Analyst will be reporting to the SCM Manager.Qualifications:With at least 2 years of working experience in PSI (Purchase, Sales, Inventory), Demand Planning, Forecasting, Materials Requirements...

GENERAL RESPONSIBILITIES:As a Platform Administrator within the Security Operations Unit, you will play a critical role in safeguarding the organization's IT systems. You will be responsible for managing, administering, and optimizing various cybersecurity technologies, including but not limited to Web Application Firewalls (WAF), Anti-Distributed...

Med Health Connect Outsourcing Inc. is looking for a Data Analyst to join our team. The Data Analyst is responsible for managing our master data set and developing respective reports/visualizations. Job Description: A data analyst systematically collects, processes, and performs statistical analyses on data sets. Job Responsibilities: Managing master data,...

A Service Desk Analyst plays a crucial role in providing technical support and assistance to users within an organization. Their primary responsibility is to address and resolve IT-related issues, inquiries, and requests from employees or users. The role involves a combination of technical expertise, strong communication skills, and a customer-centric...

QualificationsAt least 2 years of relevant BPO experience as a Quality Auditor for Clinical AuthorizationWilling to report onsite and on a night shift scheduleResponsibilitiesContact insurance carriers to verify patient's insurance eligibility, benefits and requirements. Request, track and obtain pre-authorization from insurance carriers within time allotted...

The Senior Testing Analyst - Contract months) will write and execute test scenarios and scripts to support delivery of an enterprise wide digital business transformation, manage issues to resolution, and mentor and direct the work of junior test analysts and team members.Responsibilities:Document detailed functional and end-user test scenarios and cases...