PHRN - Clinical Denials and Appeals
4 weeks ago
Work set up: Onsite Opportunity – MCK Taguig, Cyber Sigma Building
Work schedule: Weekdays Night Shift schedule, Fixed Weekends Off
Responsibilities- Effectively review inpatient and/or outpatient medical necessity and authorization denials to determine and understand the validity of such denials in a timely manner -- Should conduct comprehensive reviews of the claim denial and account, to make determinations of what action to be taken to obtain reimbursement.
- Utilize payer policies, MCG and InterQual criteria to determine if account meets criteria for appeal
- Should write an appeal letter to payer using appropriate clinical indicators, citing Official Coding Guidelines, and documentation from within the patient's medical record
- Perform all other necessary steps on the specified accounts per Clients SOP’s including documentation in the EMR, including appeal package creation
- Manage the accounts until payment is received, the account is written-off, transferred to patient-liability, or other adjudication / movement within the system that is appropriate and agreed upon by both Parties
- Reporting quality results, tracking and trending of educational opportunities of the coding and CDI specialists, responding to client subject matter needs, and providing educational support and training
- PH Registered Nurse with experience in doing medical necessity appeals, lack of authorization appeals.(6 months needed)
- Proficient in reading Explanation of Benefits (EOB) and investigating denial root causes.
- Must be skilled in navigating various payer and provider portals.
- Typing speed of at least 45 WPM.
- Strong command of the English language, both spoken and written.
- Willing to work night shifts to communicate with payers.
- Familiarity with MCG and InterQual is a plus.
- Must NOT hold a USRN license
-
PHRN – Clinical Authorization
4 weeks ago
Taguig, Philippines Go-Get Data Consultancy Full timeOverview Job title: PHRN – Clinical Authorization Work set up: Onsite Opportunity – MCK Taguig, Cyber Sigma Building Work schedule: Weekdays Night Shift schedule, Fixed Weekends Off Salary: 45K to 50K package if licensed PHRN, salary for approval if non-licensed Responsibilities Contact insurance carriers to verify patient’s insurance eligibility,...
-
Taguig, Philippines HR TechX Corp. Full timeWe're Hiring: PHRN Quality Auditor Clinical Services Location: Onsite, Mckinley, Taguig Schedule: Night Shift | Monday to Friday Hiring Target Date: Preferably by July 21, 2025 Salary Range: Up to 50k Qualifications Must hold an active PHRN license (Not a USRN holder) Prior experience as a Quality Auditor in a healthcare BPO clinical setting Alternatively, 4...
-
Taguig, Philippines HRTX Full timeAbout the job PHRN - Utilization Review / Clinical Authorization We're Hiring: PHRN Quality Auditor Clinical Services Location: Onsite, Mckinley, TaguigSchedule: Night Shift | Monday to FridayHiring Target Date: Preferably by July 21, 2025 Salary Range: Up to 50k Qualifications Must hold an active PHRN license (Not a USRN holder)Prior experience as a...
-
Taguig, Philippines HRTX Full timeWe're Hiring: PHRN Quality Auditor Clinical Services Location: Onsite, Mckinley, Taguig Schedule: Night Shift | Monday to Friday Hiring Target Date: Preferably by July 21, 2025 Salary Range: Up to 50k Qualifications Must hold an active PHRN license (Not a USRN holder) Prior experience as a Quality Auditor in a healthcare BPO clinical setting Alternatively, 4...
-
PHRN - Prior Authorization
4 weeks ago
Taguig, Philippines HRTX Full timeAbout the job PHRN - Prior Authorization Quality Auditor hiring Clinical Authorization Process.Onsite, Night Shift, Mon-Friday Qualifications Must hold an active PHRN license (not a USRN license holder) Relevant experience as a Quality Auditor in Clinical Services within a healthcare BPO environment; alternatively, 4 to 7 years of specialized experience ...
-
PHRN - Prior Authorization
1 day ago
Taguig, Philippines HRTX Full timeQuality Auditor hiring Clinical Authorization Process. Onsite, Night Shift, Mon-Friday Qualifications Must hold an active PHRN license (not a USRN license holder)Relevant experience as a Quality Auditor in Clinical Services within a healthcare BPO environment; alternatively, 4 to 7 years of specialized experience in Clinical Authorization or Utilization...
-
PHRN Clinical Trainer
2 days ago
Taguig, National Capital Region, Philippines Access Healthcare Services Manila, Inc. Full time ₱900,000 - ₱1,200,000 per yearWe are seeking a motivated and experienced PHRN Clinical Trainer to join our Healthcare Business Processing Outsourcing Team. In this role, you will be responsible for overseeing the clinical training programs, ensuring deployed employees possess the necessary skills and knowledge to deliver exceptional services to our clients. The ideal candidate will have...
-
PHRN Clinical Trainer
2 days ago
Taguig, National Capital Region, Philippines Access Healthcare Full time ₱480,000 - ₱600,000 per yearPHRN – Clinical TrainerWe are seeking a motivated and experienced Clinical Trainer to join our HealthcareBusiness Processing Outsourcing Team.In this role, you will be responsible for overseeing the clinical training programs, ensuringdeployed employees possess the necessary skills and knowledge to deliver exceptionalservices to our clients. The ideal...
-
PHRN Quality Analyst
2 days ago
Taguig, National Capital Region, Philippines Access Healthcare Full time ₱480,000 - ₱540,000 per yearPHRN – Quality AnalystWe are currently looking for Registered Nurse Quality Analyst to be part of our ClinicalteamThe Quality Analyst will be responsible for monitoring and evaluating the quality ofcustomer service interactions, identifying areas for improvement, and ensuringcompliance with policies and procedures. The successful candidate must be a...
-
Taguig, Philippines Nezda Technologies Inc. Full timeOverview Urgent Hiring for PHRN & USRN! Start ASAP! Virtual Process Only! Get your JO Now! Work Onsite: BGC, Taguig City Position: PHRN - Telephonic Case Manager Responsibilities Evaluate treatment authorization requests based on state guidelines and medical necessity, making a decision to approve or deny. If denied, refer the request to an independent...
