Utilization Review Coordinator
18 hours ago
Role Overview: We are looking for a detail-oriented Utilization Review Coordinator/Medical Management Resolution Specialist to join our team. The ideal candidate will have experience in medical coding within the US healthcare system, whether certified or non-certified, and a strong background in medical management resolution. Key Responsibilities Collect, verify, and input information accurately to ensure everything is in place before passing it to a nurse for clinical review. Conduct thorough reviews of disputed medical claims to determine the medical necessity of services provided to members. Collaborate with healthcare providers, coders, and payers to clarify documentation and ensure accurate coding and claim resolution. Assist in resolving denials, discrepancies, and other issues related to medical management and billing. Maintain detailed records of case resolutions and communicate updates to relevant stakeholders. Support process improvement initiatives to enhance accuracy and efficiency in medical management resolution. Ensure compliance with company policies and regulatory standards. Accurately input case details, clinical data, and communications into internal systems. Maintain records of all correspondence, decisions, and outcomes related to IDR cases. Ensure all documentation is complete and compliant with federal regulations. Facilitate communication between clinical teams and administrative staff to ensure accurate and timely submissions. Assist in drafting, editing, and updating Standard Operating Procedures (SOPs). Qualifications: College level education. Minimum of 2 years related experience in medical management resolution or Utiliza administrative work. Certified Medical Coders or Non-Certified Experienced Medical Coders with US healthcare experience, an advantage Strong understanding of medical coding systems and healthcare terminology. Excellent problem-solving, communication, and analytical skills. Willingness to work onsite in Ortigas and on a night shift schedule. Detail-oriented with the ability to manage multiple cases efficiently. Perks and Benefits: 15% Night Differential HMO coverage after 30 days of employment (with option to add up to 2 dependents) Retirement Benefits 24 Leave Credits per year (convertible to cash) Wholistic Employee Wellness Program Why Join Visaya KPO? Be part of a multi-awarded, 100% Filipino-owned company recognized for its leadership and innovation in the outsourcing industry1. Work in a culture that values professional growth, employee well-being, and long-term partnerships. Enjoy industry-leading benefits and a supportive, inclusive environment. Visaya KPO is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. #visayajobs Job Type: Full-time Benefits: Company Christmas gift Company events Health insurance Opportunities for promotion Paid training Promotion to permanent employee Ability to commute/relocate: Ortigas: Reliably commute or planning to relocate before starting work (Required) Experience: US Medical Coding: 2 years (Preferred) License/Certification: Medical Coding license/certification (Preferred)
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Utilization Review Coordinator
4 weeks ago
Pasig, Philippines VISAYA Full timeRole Overview We are looking for a detail-oriented Utilization Review Coordinator/Medical Management Resolution Specialist to join our team. The ideal candidate will have experience in medical coding within the US healthcare system, whether certified or non-certified, and a strong background in medical management resolution. Responsibilities Collect, verify,...
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Utilization Review Coordinator
4 weeks ago
Pasig, Philippines Visaya KPO Full timeRole Overview: We are looking for a detail-oriented Utilization Review Coordinator/Medical Management Resolution Specialist to join our team. The ideal candidate will have experience in medical coding within the US healthcare system, whether certified or non-certified, and a strong background in medical management resolution. Key Responsibilities Collect,...
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Utilization Review Coordinator
2 weeks ago
Pasig City, Philippines Visaya KPO Full timeRole Overview: We are looking for a detail-oriented Utilization Review Coordinator/Medical Management Resolution Specialist to join our team. The ideal candidate will have experience in medical coding within the US healthcare system, whether certified or non-certified, and a strong background in medical management resolution. Key Responsibilities Collect,...
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Utilization Review Nurse, USRN
4 weeks ago
Pasig, Philippines VISAYA Full timeOverview Visaya Pasig, National Capital Region, Philippines — 1 week ago Be among the first 25 applicants. Role Overview: We are seeking a skilled Utilization Management/Review Nurse to join our team. This role is essential in ensuring patients receive appropriate, timely, and cost-effective care by reviewing medical records, treatment plans, and...
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Utilization Review Nurse, USRN
4 weeks ago
Pasig, Philippines Visaya KPO Full timeRole Overview: We are seeking a skilled Utilization Management/Review Nurse to join our team. This role is essential in ensuring patients receive appropriate, timely, and cost-effective care by reviewing medical records, treatment plans, and healthcare resource utilization. Key Responsibilities: Conduct concurrent and retrospective reviews of patient...
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Utilization Review Nurse, USRN
18 hours ago
Pasig, Philippines Visaya KPO Full timeRole Overview: We are seeking a skilled Utilization Management/Review Nurse to join our team. This role is essential in ensuring patients receive appropriate, timely, and cost-effective care by reviewing medical records, treatment plans, and healthcare resource utilization. Key Responsibilities: Conduct concurrent and retrospective reviews of patient...
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Utilization Review Nurse, USRN
2 weeks ago
Pasig City, Philippines Visaya KPO Full timeRole Overview: We are seeking a skilled Utilization Management/Review Nurse to join our team. This role is essential in ensuring patients receive appropriate, timely, and cost-effective care by reviewing medical records, treatment plans, and healthcare resource utilization. Key Responsibilities: Conduct concurrent and retrospective reviews of patient...
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Clinical Review Nurse
7 days ago
Pasig, National Capital Region, Philippines Connext Global Solutions Inc Full time ₱900,000 - ₱1,200,000 per yearAbout ConnextConnext is a team of business process outsourcing experts serving world-class clients in industries like Healthcare, Title and Escrow, Retail and Fashion, Produce Distribution, Design Consulting, and Finance.We are currently hiring a Clinical Review Nurse to work with one of our healthcare clients based in the U.S. What's in it for...
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Credit Review Associate
18 hours ago
Pasig, Philippines CEPAT KREDIT FINANCING INC. Full timeRoles and Responsibilities: Protect the company from fraudulent accounts by doing thorough investigations and review of all accounts being processed. Conduct a thorough analysis of loan applications, financial statements, credit reports, and other relevant documentation to assess the creditworthiness of borrowers. Evaluate the risk profile of borrowers by...
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Credit Review Associate
4 days ago
Pasig City, Philippines CEPAT KREDIT FINANCING INC. Full timeRoles and Responsibilities: Protect the company from fraudulent accounts by doing thorough investigations and review of all accounts being processed. Conduct a thorough analysis of loan applications, financial statements, credit reports, and other relevant documentation to assess the creditworthiness of borrowers. Evaluate the risk profile of borrowers by...
