PHRN Clinical Auditor

QualificationsAt least 1 year of relevant BPO experience as a Clinical Authorization SpecialistPHRN licensed Willing 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...

AVAILABLE POSITIONSUtilization Management Reviewer - At least 1 yr experience as UMR + 6 mos clinical/hospital experience (PHRN)Clinical Authorization Specialist - At least 1 yr background in Clinical Authorization + 6 mos clinical/hospital experience (Non-Registered Nurses are welcome to apply)Clinical Team Leader - At least 5 years of relevant BPO...

Accessheathcare is looking for MEDICAL CODERS to join our growing team HR INTERVIEW AND FINAL INTERVIEW ONLY Qualifications:Must be PHRN with active LicenseMust have an active medical coding license Can analyze medical records and identify documentation deficienciesAble to apply appropriate ICD and CPT codes for the ordered procedureStrong knowledge of...

AVAILABLE POSITIONSUtilization Management Reviewer - At least 1 yr experience as UMR + 6 mos clinical/hospital experience (PHRN)Clinical Authorization Specialist - At least 1 yr background in Clinical Authorization + 6 mos clinical/hospital experience (Non-Registered Nurses are welcome to apply)Clinical Team Leader - At least 5 years of relevant BPO...

(Must be a PHRN with BPO background in healthcare) GENERAL PROFILEMaintains an active PHRN license essential to deliver the role/function.Has at least 2-year related process or clinical experienceHas orientation/experience on audit process for at least 1-2 years (data entry or telephonic) Proficient in a range of operational processes through prior...

Cognizant is a global organization serving clients across multiple industries with a deep set of offerings provided by our practice areas and supported by corporate and enabling functions. Employing roughly 270,000 talented associates worldwide, Cognizant is dedicated to anticipating and solving clients' toughest problems and enabling them to thrive in the...

QualificationsAt least 1 year of relevant BPO experience as a Utilization Review NursePHRN licensed Willing to report onsite and on a night shift scheduleJob DescriptionProvide health care utilization review services regarding admissions, observations, Discharge Wqs based on the payer types and review types. Review admissions and service requests within...

Exciting Opportunities for our REGISTERED NURSES (PHRN) You will be responsible in assisting clients with the services, medications and coverage of their insurance. Available opening:Nurse Associate - At least 1 year of hospital bedside experienceUtilization Management Review - At least 1 year of clinical appeals and denials or utilization reviewUSRN Academy...

JOB SUMMARYThe Quality Analyst in Clinical Abstracting is responsible for ensuring the accuracy, completeness, and compliance of clinical data abstracted from medical records. This role involves reviewing and analyzing abstracted data, identifying discrepancies, and providing feedback to abstractors to ensure adherence to clinical guidelines, coding...

Qualifications5+ years of experience in clinical settings, clinical administrative services, and revenue cycle, of which a minimum of 2 years should be in an Assistant Manager and above role.Preferably with 5 years managing project and operational improvement efforts within RCM (Coding and Clinical Administrative Services including CDI).Deep expertise in...

WE ARE RAMPING FOR PHRN Location: Bridgetown, Quezon CityStart Date: ASAP You are responsible for answering and resolving inbound telephone calls pertaining to medical products and services about benefit, claim or eligibility and non- clinical Utilization Management issues from a Doctor/Hospital regarding (1) one or more issues about a single Customer, or...

LOCATION: BRIDGETOWN QC EXTENSION OF PASIGNIGHSHIFT WITH 20% NIGHT DIFFOFFER: 31K SALARY PLUS 30K BONUSNONVOICE - BACK OFFICENEED 1 YEAR CLINICAL EXPERIENCESTART ASAP THIS AUGUSTACTIVE PRCWORK ONSITEBENEFITS: HMO DAY1 WITH 13TH AND 14TH MONTH PAY

Qualifications:Candidate must be a graduate of Bachelor of Science in NursingMust be a PHRN License holder onlyPreferably with 1-year any direct patient care experience/Clinic/Company/School NurseKnowledgeable in MS Office and Internet browsingCan start ASAPNo BPO experience? We got you Amenable to work onsite ( Quezon City Bridgetowne )NO PENDING NCLEX...

Key Responsibilities Manage and audit medical bills and records. Validate coding (ICD/PT/DRG) and apply fee schedules. Negotiate provider fees and leverage costsaving opportunities. Provide clinical support and training to Medical Services Representatives. Contribute to the development of the Clinical Bill Review program.Qualifications Must have an Active...

Duties & ResponsibilitiesWork post discharge, prebill accounts efficiently and effectively on a daily basis to resolve accounts with "no auth numbers, ALOS vs. authorized days or other discrepancies  Evaluates clinical documentation on multiple patient accounts and escalates issues through the established channels Perform accurate and timely...

Key Responsibilities Manage and audit medical bills and records. Validate coding (ICD/PT/DRG) and apply fee schedules. Negotiate provider fees and leverage costsaving opportunities. Provide clinical support and training to Medical Services Representatives. Contribute to the development of the Clinical Bill Review program.Qualifications Must have an Active...

Lead Assistant Manager – Healthcare Clinical Process Training (MOA Pasay) Position Overview:The primary responsibility of this role is to work with the team of assistant managers to oversee the quality of deliverables, manage team relationships, and assessing developmental/training needs of employees and process. The Lead Assistant Manager is always...

Cotiviti Philippines is currently hiring for the following positions in the Inpatient Clinical Chart Validation department. Please note that these are onsite opportunities: Operations ManagerAt least 2 years' experience working as an assistant manager or managerMust have experience in Inpatient DRG Must be willing to be assigned in Cebu (relocation...

ROLE AND RESPONSIBILITIESAudits within the DRG Validation Audit Program involve determining whether coding on a claim submission is supported by medical record documentation.They also check if the codes are in accordance with industry coding standards as outlined by the Official Coding Guidelines, the applicable ICD Coding Manual, and/or Coding Clinics. Your...

nXscale provides flexible outsourcing solutions for startups and scaleups. We partner with global companies to help them build teams and scale operations.Our client is an extremely fast growing organization on a mission to deliver high touch, high quality care to millions of patients. They house consumer healthcare brands built off a core shared technology...