Clinical Appeals

Nezda is looking for PH Registered Nurse. Salary: P48,000Qualifications: Active PHRN license. Must have at least 2 years experience in clinical appeals or utilization review/management. Experienced in prior authorization and clinical appeals.

Description: Responsible for collaborating with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources. Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and...

Description: Responsible to manage a team of clinicians charged with promoting quality member outcomes, to optimize member benefits, and to promote effective use of resources. Primary duties may include, but are not limited to: Ensures adherence to medical policy and member benefits in providing service that is medically appropriate, high quality, and cost...

The AR Specialist II is responsible for billing, re-billing, post-payment/account follow-up, and grievance preparation of assigned. Client Hospital Accounts Receivable. Working at a Client site or in a Centralized location, responsibilities may include account maintenance of specialized or multiple payers including state and federal government programs,...

Job Purpose: Ensure that project related quality processes are followed by associates, client specific metrics and internal metrics are achieved, provide coaching to employees, track and trend data for improvement. Primary Duties and Responsibilities: We are currently looking for a keen individual who is responsible for conducting audits for healthcare...

Primary Duties and Responsibilities: • Ensure that training and assessments happen as per statutory requirements. • Give feedback and coach trainees on key job capabilities. • Update and develop content as per client and business requirements. • Ensure that all relevant information is updated on to the MIS trackers regularly. • Conduct regular TNA...

Job Purpose: Ensure that project related quality processes are followed by associates, client specific metrics and internal metrics are achieved, provide coaching to employees, track and trend data for improvement. Primary Duties and Responsibilities: We are currently looking for a keen individual who is responsible for conducting audits for healthcare...

Primary Duties and Responsibilities: • Ensure that training and assessments happen as per statutory requirements. • Give feedback and coach trainees on key job capabilities. • Update and develop content as per client and business requirements. • Ensure that all relevant information is updated on to the MIS trackers regularly. • Conduct regular TNA...