Medical Necessity Evaluator

Responsibilities:-Review inpatient medical records to ensure accurate ICD-10-CM, ICD-10-PCS, and DRG coding.-Collaborate with physicians, nurses, and clinical teams to improve documentation quality and completeness.-Conduct clinical documentation reviews to ensure compliance with CMS, AHIMA, and ACDIS guidelines.-Identify documentation discrepancies and...

Key Responsibilities- Review inpatient medical records to verify ICD-10-CM, ICD-10-PCS, and DRG coding accuracy- Collaborate with physicians, nurses, and clinical teams to enhance documentation quality and completeness- Conduct thorough clinical documentation reviews to ensure adherence to CMS, AHIMA, and ACDIS standards- Identify discrepancies in...

**Role Summary:**We are seeking a highly skilled Medical Eligibility Advisor to join our team at Recruiter PH. In this role, you will be responsible for reviewing and analyzing medical information to determine disability eligibility for short and long-term benefits.You will use your strong analytical skills to identify medical and non-medical influencing...

We are seeking an exceptional individual to fill the role of Property Evaluation Expert.The ideal candidate will possess a deep understanding of property valuation principles and have experience working with clients' accounts and credit dealings.In addition to your technical expertise, you'll need a graduate degree in any 4-year course, preferably...

Job Overview:Gratitude Philippines is seeking a highly skilled Clinical Case Manager to join our team. As a Utilization Reviewer, you will play a critical role in ensuring that patients receive necessary care while minimizing unnecessary costs. In this position, you will work closely with healthcare providers, claims adjusters, and other stakeholders to...

Roles and Responsibilities:PH Registered nurses to review workers compensation claims with serious injury and that need surgery/lengthy treatments, create a return-to-work plan, work with various stakeholders (medical providers, injured worker, employer, attorney) to track the treatment plan and help bring the injured worker back to work.Nurses have...

Job Description:In this pivotal role, you will serve as a liaison between healthcare providers and insurance companies, ensuring that patients receive medically necessary care while adhering to cost-effective standards. As a Utilization Reviewer, you will utilize your exceptional clinical skills to evaluate treatment plans, make informed decisions about...

About the Role:As a Medical Case Manager at Gratitude Philippines, you will play a critical role in ensuring that injured employees receive appropriate medical care and support to return to work safely and efficiently. You will be responsible for reviewing workers' compensation claims, developing return-to-work plans, and collaborating with various...

Roles and Responsibilities:• PH Nurses to review treatment authorization request based on state guidelines and medical necessity and take decision to approve/deny. In case of denial send this to independent panel review to support the decision. Nurses will work with Claims adjuster on denial decision based on risk tolerance to ensure the denial doesn't...

Summary:The Clinical Review Nurse position assesses the medical appropriateness of proposed treatments and medications for our injured employees, and partners with the Client Claims Adjuster team to expedite medically necessary treatment for each claim. Maintains a solid understanding of Client's mission, vision, and values. Upholds the standards of the...

Job Description: Training Specialist - Medical CodingTASQ Staffing Solutions is currently seeking a Training Specialist - Medical Coding to work onsite in Taguig.Responsibilities:The Training Specialist will be responsible for developing, implementing, and evaluating training activities at Shearwater Health. This includes planning, assessing, organizing,...

Job OverviewWe are currently seeking an experienced Physiotherapy Coordinator to join our team at the Medical Center of Taguig City, Inc.About the PositionThe successful candidate will be responsible for coordinating with medical professionals to ensure the effective delivery of physical therapy services.Main ResponsibilitiesEvaluate patient condition and...

About the RoleICU RN Auditor WantedGo-Get Data Consultancy is seeking an experienced ICU RN Auditor to join our team. As an ICU RN Auditor, you will be responsible for reviewing and assessing medical records, coding accuracy, and documentation compliance in intensive care units.This role requires a strong background in critical care nursing, medical...

Company Overview:TASQ Staffing Solutions is a leading staffing solutions provider that offers innovative solutions for businesses. We strive to deliver top-notch talent and exceptional customer service.Job Summary:We are seeking an experienced MEDICAL CODING TEAM LEAD to manage our medical coding team and contribute to the company's...

Braun Melsungen AG is committed to delivering comprehensive patient care across the globe.We are searching for an experienced Sales and Marketing Professional to promote and sell medical products or services to healthcare professionals, institutions, and distributors.This role demands a profound understanding of medical products, successful sales strategies,...

About J-K Network ServicesWe are a leading provider of technical support services, dedicated to delivering exceptional customer experiences. Our team is passionate about staying up-to-date with the latest developments in medical technology, ensuring that our clients receive the highest level of support.Job ResponsibilitiesMonitor and respond quickly to...

About J-K Network ServicesWe are a leading provider of technical support services, dedicated to delivering exceptional customer experiences. Our team is passionate about staying up-to-date with the latest developments in medical technology, ensuring that our clients receive the highest level of support.Job OverviewThis role is perfect for a motivated and...

Responsibilities:Research, plan, develop, implement and evaluate training strategies, initiatives, and materials including comprehensive education programs to meet orientation and ongoing competency needs and professional development needsAssess data and information related to claim medical outcome and other pertinent situations including identification of...

Registered Nurse for Healthcare BPO | Non VoiceCompany: Access Healthcare ServicesLocation: On-site - TaguigExperience: 1-3 YrsEmployment Type: Full-timeJob DescriptionDescriptionCompany DescriptionAccess Healthcare provides business process outsourcing, application services, and robotic process automation tools to healthcare providers worldwide. With 20...

About the Role:We are looking for an experienced Senior HR Reporting Partner to join our team at CH01 CHE Fresenius Medical Care (Schweiz) AG. In this role, you will be responsible for delivering high-quality reporting solutions that meet the needs of assigned business functions/COEs.The ideal candidate will have strong analytical skills and experience...