Clinical Appeals Nurse

23 hours ago

Mabalacat, Philippines Buscojobs Full time

Clinical Denials and Appeals Nurse (Pasay, Camarines Sur)

Company: Access Healthcare Services Manila, Inc. • Posted today

Job Type: Full-time

Salary: ₱900,000 - ₱1,200,000 per year

Description:

Access Healthcare is looking for a REGISTERED NURSE to join our growing team. You’ll be ensuring the completion of assigned patient cases by performing roll calls, processing concurrent and retro clinical reviews, and processing surgery authorizations as needed.

Responsibilities :

  • Perform advanced level work related to clinical denial and utilization management.
  • Manage medical denials by conducting a comprehensive review of clinical documentation.
  • Handle audit/compliance responsibilities and other administrative duties as required.
  • Write compelling arguments based on clinical documentation and payer policies; submit appeals in a timely manner.
  • Resolve charge problems to ensure accurate and complete billing; inform staff on proper billing, follow-up, and documentation practices.
  • Review and rectify errors in third-party payer reimbursement denials based on documentation, billing accuracy, medical necessity, coding, modifiers, and related issues.
  • Actively manage, maintain, and communicate denial or appeal activity to stakeholders; report suspected or emerging trends to Revenue Cycle management.

Qualifications :

  • Must be Registered Nurse with Active license
  • Hospital bedside experience (OR/ER/ICU/PACU/General Wards/After Surgery Care)
  • Experience in BPO Healthcare account is a definite advantage (Insurance, Denials & Appeals, Coding, Utilization Review, Prior Authorization, etc.)
  • Amenable to work onsite at Double Dragon, Pasay
  • Available to start ASAP

Note: This posting may include multiple roles with similar responsibilities; details above pertain to the Clinical Denials and Appeals Nurse position.

We encourage qualified candidates to apply now.

Other Registered Nurse Roles (Summary)

Several additional RN opportunities are listed in this posting with similar requirements (PH Registered Nurse, US Registered Nurse, Clinic Nurse, and other positions) including responsibilities in utilization review, clinical documentation, patient care, and related planning. These roles vary by location, salary, and job type. See individual postings for full details and eligibility.

Equal Opportunity and safeguarding statements included per posting: LoveYourself Inc. and related organizations emphasize equal opportunity, safeguarding, screening processes, and compliance requirements as described in the provided content.

#J-18808-Ljbffr

  • Nursing Instructor

    4 days ago

    Mabalacat, Central Luzon, Philippines JOSE C. FELICIANO COLLEGE FOUNDATION Full time ₱144,000 - ₱216,000 per year

    Jose C. Feliciano College Foundation is looking for: Nursing InstructorsWe are seeking a full-time, compassionate, and highly adaptable Nursing Instructors to join our faculty. The ideal candidate will demonstrate a strong commitment to supporting nursing students throughout their academic and clinical education. The successful applicant will be proficient...

  • Nursing Instructor

    4 days ago

    Mabalacat, Central Luzon, Philippines Jose C. Feliciano College Foundation Inc. Full time ₱900,000 - ₱1,200,000 per year

    Job description:Jose C. Feliciano College Foundation is looking for: Nursing InstructorsWe are seeking a full-time, compassionate, and highly adaptable Nursing Instructors to join our faculty. The ideal candidate will demonstrate a strong commitment to supporting nursing students throughout their academic and clinical education. The successful applicant will...

  • Nurse

    4 days ago

    Mabalacat, Central Luzon, Philippines Quanta Paper Corporation Full time ₱800,000 - ₱1,200,000 per year

    Bachelor of Science in Nursing (BSN) or equivalent.Must be a Registered Nurse (RN) with valid PRC license.With relevant clinical or hospital experience (preferred but not always required).Knowledgeable in patient care, medical procedures, and healthcare protocols.Strong communication and interpersonal skills.Ability to work under pressure and in a team...

  • Company Nurse

    4 days ago

    Mabalacat, Central Luzon, Philippines Target Lighting Mftg. Corp. Full time ₱200,000 - ₱300,000 per year

    Key Responsibilities:Provide first aid and emergency care: Administering basic first aid to employees in case of injuries or sudden illnesses.Conduct health assessments: Performing pre-employment and annual physical examinations and assessing employee health needs.Develop and implement health programs: Creating and executing health and safety programs,...

  • School Clinic Assistant

    4 days ago

    Mabalacat, Central Luzon, Philippines JOSE C. FELICIANO COLLEGE FOUNDATION Full time ₱288,000 - ₱720,000 per year

    Jose C. Feliciano College Foundation is looking for a compassionate, dependable, and organized Clinic Assistant to support the daily operations of the school clinic and promote the health and wellness of our students, faculty, and staff. The ideal candidate is a graduate of any 2-year or 4-year health-related course or an undergraduate currently pursuing a...

  • School Nurse

    4 days ago

    Mabalacat P, Philippines National University Clark Full time ₱400,000 - ₱600,000 per year

    Summary:The School Nurse is responsible in the administration of emergency treatment and medication to students and employees. This position also covers assisting the School Physician and School Dentist in all clinical activities.Qualifications:Graduate of Bachelor's degree in Nursing.With valid PRC license as Registered Nurse.At least three years of...

  • Company Nurse-Pampanga

    4 days ago

    Mabalacat, Central Luzon, Philippines Quanta Paper Corporation Full time ₱300,000 - ₱450,000 per year

    Job DescriptionCandidate must possess at least Professional License (Passed Board/Bar/Professional License Exam) in Nursing or equivalent.At least 2 Year(s) of working experience in the related field is required for this position.Required Skill(s): Microsoft Office, Microsoft ProjectPreferably 1-4 Yrs Experienced Employee specialized in Healthcare -...

  • General practitioner

    4 days ago

    Mabalacat, Central Luzon, Philippines Eirene Clinic & Pharmacy Full time $60,000 - $80,000 per year

    About the role We're seeking a part-time General Practitioner to join our dynamic team at Eirene Clinic in Mabalacat City, Pampanga. As a key member of our healthcare team, you will be responsible for providing comprehensive primary care services to our valued patients. This is an exciting opportunity to make a meaningful impact on the lives of the local...

  • Health Services Auxiliary Aide

    1 week ago

    Mabalacat P, Philippines National University Clark Full time ₱200,000 - ₱250,000 per year

    Summary:The Health Services Auxiliary Aide is responsible in assisting the school nurses in the administration of emergency treatment and medication to students and employees. This position also covers assisting the School Physician and School Dentist in all clinical activities.Qualifications:Graduate of Bachelor's degree in Nursing or any related...