Clinical Denials Specialist

4 days ago

Pasig, Philippines Coronis Health Philippines Full time

Clinical Denial Representative is responsible to review patient’s medical claim when resolving edits for compliance (prior billing) and issues on rejections(rejected by the payor) in the physician side. Clinical Denial Representative must understand and comply with federal and state coding and billing regulation. The Clinical Denial Representative must ensure the confidentiality and privacy of information.

Key Responsibilities

1. Prepare and process accounts timely and accurately based on client requirement.
2. Review daily account/edit reports from work queues and/or in external billing software
and makes necessary corrections or resolve edits to allow electronic submission.

a. Resolving edits prior billing (Compliance)
b. Resolving rejections from the payor (Rejection)
3. Reviews and make appropriate actions such as but not limited to:
a. Medical Necessity edits,
b. Local Coverage Determination (LCD) and National Coverage Determination (NCD)
edits
c. National Correct Coding Initiative (NCCI) edits
d. Modifier edits
e. Payer specific edits
f. Medically Unlikely Edits (MUE)
g. Procedure to Procedure (PTP) edits
h. Diagnosis issue
4. Enter appropriate account notes into the billing system to clarify actions taken to reconcile claims.
5. Maintains confidentiality of patient records at all times Observes HIPAA compliance.
6. Perform as a team player.
7. Use logic, critical thinking and reasoning to identify the strengths and weaknesses of alternative solutions to problems.
8. Understand the effects of new information for both current and future problem-solving and decision-making.
9. High attention to detail
10. Attendance in accordance with company HR and department policies
11. Other tasks/functions that may be assigned by the company as per business
requirement; these may change from time to time to reflect the changing requirementof your position and our business

Qualifications:
Bachelor of Science in Nursing or Medical Allied Health Course.
Preferred experience in revenue cycle (medical coding), knowledge of ICD-10, CPT procedures, and clinical or hospital settings.
Certification required: AAPC (CPC, COC, CIC) or AHIMA (CCA, CCS-P, CCS).
Willingness to work on temporary work from home set-up.

  • Clinical Content Manager

    2 weeks ago

    Pasig, National Capital Region, Philippines beBeeCoding Full time ₱1,200,000 - ₱1,500,000

    Medical Coding SpecialistWe are seeking a highly skilled Medical Coding Specialist to join our team.The successful candidate will be responsible for conducting research and identifying medical coding and billing documents to improve claims editing solutions.Key responsibilities include:Conducting thorough research on Medicare, Medicaid, and other medical...

  • Clinical Appeals Nurse

    1 day ago

    Pasig, National Capital Region, Philippines Coronis Health Full time ₱1,200,000 - ₱2,400,000 per year

    Company DescriptionAt Coronis Health, we specialize in revenue cycle management (RCM) with a focus on simplifying complexities for healthcare providers to enable them to deliver exceptional patient care. We offer tailored solutions for billing optimization, claims management, and actionable insights to support growth and scalability for each unique practice....

  • Medical Coding and Billing Expert

    2 weeks ago

    Pasig, National Capital Region, Philippines beBeeContentSpecialist Full time $65,000 - $89,900

    Job DescriptionWe are seeking a skilled Clinical Content Specialist to join our team. In this role, you will be responsible for conducting research and identifying Medicare, Medicaid, and other medical coding and billing documents to identify claim denial or covered criteria (clinical content) for our automated claims editing solution.The clinical content...

  • Clinical Application Specialist

    4 hours ago

    Pasig, Philippines Progressive Medical Corporation Full time

    Job Summary Clinical Application Specialist (CAS) plays a key role in assisting sales and ensuring the successful adaptation of hospital equipment in healthcare facilities. The role involves engaging with hospital and clinics, demonstrating medical equipment, and providing technical and clinical expertise to healthcare professionals.This specialist will work...

  • Clinical Utilization Specialist

    2 weeks ago

    Pasig, National Capital Region, Philippines beBeeReviewer Full time ₱45,000 - ₱65,000

    Job OpportunityWe are seeking a Clinical Utilization Reviewer to fill a key role in our organization. As a critical member of the team, you will be responsible for examining healthcare utilization and managing appeals processes.About the PositionA successful candidate will possess active PHRN and USRN Mainland License certifications.Prior experience in...

  • Primary Care Clinic Medical Coding Specialist

    2 weeks ago

    Pasig, National Capital Region, Philippines beBeeCoder Full time ₱600,000 - ₱800,000

    Medical Coding Specialist - Primary Care ClinicWe are seeking an experienced and detail-oriented medical coding specialist to join our team. The ideal candidate will have extensive experience in coding for primary care services and a thorough understanding of medical coding guidelines and regulations.This role is pivotal in ensuring accurate and compliant...

  • Clinical Training Manager

    3 days ago

    Pasig, National Capital Region, Philippines Omega Healthcare Management Services Inc. Full time ₱1,200,000 - ₱2,400,000 per year

    PRIMARY DUTIES AND RESPONSIBILITIES:· Project- manages the smooth roll out of courses at the location.· Work on areas identified for improvement based on feedback received about the quality of the training programs.· To ensure confidentiality, integrity and availability of all data dealt in course of work· To ensure the completion of compliance awareness...

  • Clinical Documentation Coordinator

    1 week ago

    Pasig, National Capital Region, Philippines beBeeDocumentation Full time $9,600

    Job Title:Medical Documentation SpecialistA Medical Documentation Specialist works closely with healthcare providers to document clinical interactions in real-time, ensuring accurate and detailed patient records. This role allows medical professionals to focus more on patient care by handling the documentation side of the encounter.Key...

  • Insurance Claims Examiner

    2 weeks ago

    Pasig, National Capital Region, Philippines beBeeInsurance Full time ₱13,500

    Job Overview:We are seeking a highly organized Insurance Verification Specialist to support our insurance and authorization operations.Verify patient insurance coverage, ensuring accuracy and eligibility for proposed healthcare services.Prepare and submit comprehensive authorization requests to insurance companies with all required documentation.Collaborate...

  • Professional Clinical Operations Professional

    2 weeks ago

    Pasig, National Capital Region, Philippines beBeeClinicalOperations Full time $75,000 - $105,000

    Clinical Operations Specialist About the Role This role plays a pivotal part in ensuring exceptional delivery of clinical services across various channels. You will serve as a key clinical operations representative for enterprise clients, responsible for delivering high-quality services and maintaining strong client relationships. Main Responsibilities The...