Clinical Denials Clinician

**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...

Clinical Denials and Appeals NurseWe are an analytics-driven, technology-enabled revenue cycle management company looking for a skilled Clinical Denials and Appeals Nurse with at least 1 year of relevant BPO experience. The ideal candidate will have a PHRN license, 6 months of hospital experience, and be willing to work a night shift...

Job Description**Summary:** Clinical Denials and Appeals Nurse with 1+ year BPO experience, PHRN license, and 6+ months hospital experience, willing to work onsite at McKinley West, Taguig, on a night shift schedule.**Responsibilities:*** Review inpatient and/or outpatient medical necessity and authorization denials to determine validity.* Conduct...

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...

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...

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

We are seeking a highly motivated professional with expertise in clinical knowledge, healthcare staffing, people leadership, and compliance to join our team. We are looking for a highly motivated professional who is well versed in clinical knowledge, healthcare staffing, people leadership and compliance. This role will interview nurse applicants and provide...

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 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. ...

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 )

Company Overview:We are a company built on trust and loyalty. MBVA 24/7 started in 2018 and has continuously fostered skilled and talented Virtual Assistants for many clients. Our team of virtual assistants provides services all over the US, and we sure won't be stopping there Our main office is located in Arizona and Manila. We have a legion of virtual...

Let your Passion Lead You at the Home of Clinicians with over 4000+ employees who have trusted us with their careersPhysical Sites: Taguig, Cebu, and PampangaRemote Work Locations: Baguio & DavaoOur Clinicians & Associates advocates for better patient care while enjoying these benefits:HMO on Day 1 with 2 Dependents upon regularization.Group Life...

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...

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...

Registered Nurse with clinical experience sought to review claims for appropriateness of care or coverage and work directly with clients to provide input under program policy or procedural requirements. Key Responsibilities: Apply medical judgment to adjudication of cases/claims. Review requests for denial reconsideration and appeals. ...

Seeking QA Specialist to ensure accuracy and quality of clinical operations.Responsibilities:Monitor and audit work processes to improve clinical operations standards.Perform quality audits, validate results, and communicate recommendations.Design, review, and amend QA monitoring tools and guides.Create QA reports and provide data to Quality Assurance...

Quality Sleep Philippines is currently looking for MOBILE Sleep Clinicians who will be responsible in performing the following day-to-day tasks:Contacting patients to schedule setups of equipment and explain the clinical benefits of PAP therapy and dangers of sleep apneaSetting up patients with CPAP/AutoPAP/BiPAP devices and mask fittingContacting patients...

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...

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,...