Medical Necessity Specialist
5 days ago
An experienced Clinical Appeals Nurse Specialist is required to work with our team at Omega Healthcare Management Services Inc. This role involves analyzing denial of insurance claims, determining the root cause of denials, and composing appeal letters to secure proper reimbursement.
Key Responsibilities- Review activity summary, documentation, and correspondence to obtain notes related to the denial.
- Identify root cause of the denial and work on Medical Necessity and No Authorization denials, and Untimely filing only.
- Compose appeal letter if appealing the denial, considering factors such as type of denial, partial or full denial, appeal level, and payer contract language.
- Apply contract language, benefits, and covered services in researching and deciding the outcome of appeals.
- Ability to identify complex problems and review related information to develop and evaluate options.
- Proficiency in using Interqual for medical necessity reviews.
- Excellent customer service skills: communicates clearly and effectively.
- Prior experience in clinical appeals for Inpatient Denials/UR for Inpatient and Continued Stay Reviews.
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Medical Necessity Specialist
6 days ago
Manila, National Capital Region, Philippines UST Full timeJob DescriptionWe are seeking a highly skilled Clinical Appeals Coordinator to join our team at UST. As a key member of our operations, you will be responsible for independently taking customer support calls and resolving issues efficiently while ensuring quality output and accuracy of information.Key Responsibilities:Investigate and process complex...
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Medical Coding Specialist
7 days ago
Manila, National Capital Region, Philippines Theoria Medical Full timeAt Theoria Medical, we are seeking a dedicated Medical Coding Specialist to join our Quality Department.Job DescriptionWe are looking for an individual who can accurately review and analyze medical records and documentation to ensure coding accuracy.The ideal candidate will assign appropriate ICD-10, CPT, and HCPCS codes based on documentation and coding...
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Medical Coding Specialist
6 days ago
Manila, National Capital Region, Philippines Theoria Medical Full timeJob SummaryWe are seeking a highly skilled Medical Coding Specialist to join our team at Theoria Medical. As a key member of our Quality Department, you will be responsible for reviewing medical records and assigning accurate ICD-10, CPT, and HCPCS codes.About the RoleIn this role, you will support our billing department by analyzing medical documentation,...
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Medical Coding Specialist
6 days ago
Manila, National Capital Region, Philippines Theoria Medical Full timeJob SummaryWe are seeking a skilled Medical Coding Specialist to join our team at Theoria Medical. In this role, you will play a critical part in ensuring the accuracy and compliance of medical codes for various patient services.About The CompanyTheoria Medical is a comprehensive medical group and technology company dedicated to serving patients across the...
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Medical Coding Specialist
7 days ago
Manila, National Capital Region, Philippines Theoria Medical Full timeJob Summary:We are seeking a skilled Medical Coding Specialist to join our team at Theoria Medical. As a critical member of our billing department, you will play a vital role in ensuring compliance with insurance, federal, and state regulations.About the Role:You will review medical documentation to assign accurate codes for diagnoses and procedures.You will...
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Medical Device Specialist
6 days ago
Manila, National Capital Region, Philippines Aljeron Medical Enterprises, Inc. Full timeJob SummaryWe are seeking an experienced Medical Device Specialist to join our team. The ideal candidate will possess a Bachelor's Degree in Medical Technology, Biology, Nursing, Physical Therapy, or equivalent. Strong understanding of human anatomy and physiology, with the ability to comprehend medical jargon, is essential.Essential Skills and...
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Medical Sales Specialist
5 days ago
Manila, National Capital Region, Philippines Cosmo Medical Inc. Full timeManila, National Capital Region, PhilippinesMedical Sales SpecialistWe are seeking a dynamic and highly motivated Medical Sales Specialist to join our team, covering the areas of:ManilaCebuThis role is primarily responsible for promoting and selling cutting-edge medical equipment to government hospitals across the regions, with a focus on ultrasound...
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Medical Specialist
6 days ago
Manila, National Capital Region, Philippines Medical and Pharmaceutical Specialties, Inc. Full timeJob OverviewWe are seeking a Medical Specialist to join our team at Medical and Pharmaceutical Specialties, Inc. This role involves conducting free clinics in assigned territories, assisting doctors during medical missions, and educating clients on MPSI products.Key Responsibilities:Conducts free clinic in the assigned territoryAssists the doctors during...
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Medical Laboratory Specialist
16 hours ago
Manila, National Capital Region, Philippines Supercare Medical Services Inc. Full timeJob Summary:We are seeking a skilled Medical Laboratory Specialist to join our team at Supercare Medical Services Inc. This is an exciting opportunity for individuals who are passionate about delivering high-quality laboratory services.The successful candidate will be responsible for instructing and preparing examinees for different specimen collection...
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Medical Sales Specialist
5 days ago
Manila, National Capital Region, Philippines Cosmo Medical Inc. Full timeAt Cosmo Medical Inc., we are seeking a dynamic and highly motivated Medical Sales Specialist to join our team, covering the areas of Manila and Cebu. The role is primarily responsible for promoting and selling cutting-edge medical equipment to government hospitals across these regions.Key Responsibilities:Sales & Promotion: Promote and sell ultrasound...
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Medical Credentialing Expert
6 days ago
Manila, National Capital Region, Philippines Theoria Medical Full timeTheoria Medical: A Comprehensive Medical GroupAt Theoria Medical, we are dedicated to serving patients across the care continuum with an emphasis on post-acute care and primary care. Our team of healthcare professionals is passionate about delivering high-quality patient care and making a difference in the lives of those we serve.About the Role:We are...
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Medical Coding Specialist
6 days ago
Manila, National Capital Region, Philippines Theoria Medical Full timeCompany OverviewTheoria Medical is a leading medical group and technology company dedicated to delivering exceptional patient care across the care continuum. Our mission is to improve the quality of care delivered, refine facility processes, and enhance critical relationships.We offer a broad scope of services including multispecialty physician services,...
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Medical Credentialing Professional
6 days ago
Manila, National Capital Region, Philippines Theoria Medical Full timeJoin Theoria Medical, a comprehensive medical group and technology company dedicated to serving patients across the care continuum. As a Credentialing Specialist, you will play a vital role in maintaining licensure and other information for healthcare facilities.This is an exciting opportunity for a detail-oriented and organized professional with strong oral...
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Medical Specialist Opportunity
2 days ago
Manila, National Capital Region, Philippines Tula Hospital Full timeTula Hospital is currently seeking a highly skilled General Surgeon to join our esteemed medical team.This role involves examining patients, making informed diagnoses, and determining the necessity for surgical intervention.Upon encountering patients requiring urgent care, you must swiftly assess their condition and facilitate transfer to the appropriate...
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Medical Credentialing Professional
3 days ago
Manila, National Capital Region, Philippines Theoria Medical Full timeJob Title:Credentialing SpecialistAbout the Role:Theoria Medical is a comprehensive medical group and technology company dedicated to serving patients across the care continuum with an emphasis on post-acute care and primary care.Responsibilities:Maintain licensure and other information for healthcare facilities.Responsible for onboarding new hires and...
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Medical Liaison Specialist
7 days ago
Manila, National Capital Region, Philippines Theoria Medical Full timeAt Theoria Medical, we are committed to delivering exceptional patient care across the care continuum.The position of HR/Recruitment Liaison plays a vital role in supporting our recruitment efforts and ensuring seamless onboarding processes.We are seeking a highly organized and detail-oriented individual to join our team as an HR/Recruitment Liaison.The...
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Medical Credentialing Professional
6 days ago
Manila, National Capital Region, Philippines Theoria Medical Full timeAbout the RoleWe are seeking a Medical Credentialing Professional to join our team at Theoria Medical. As a leading-edge, innovative, and quality-driven physician group, we continue to expand nationally and seek talented individuals to join our amazing team.This role is responsible for maintaining licensure and other information for healthcare facilities,...
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Head of Medical Operations
5 days ago
Manila, National Capital Region, Philippines Private Advertiser Full timePlans programs, strategies and controls of the Division that are aligned to the company's objectives.Develops and formulates policies related to operations of the Division and its different Departments.Evaluates and conceptualizes the formulation and implementation of the Division's business processes, customer experience and managed care strategies for the...
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Medical Staff Credentialing Manager
6 days ago
Manila, National Capital Region, Philippines Theoria Medical Full timeAbout Theoria MedicalTheoria Medical is a leading-edge, innovative, and quality-driven physician group committed to expanding nationally and seeking talented individuals to join our amazing team.Job SummaryThis role is responsible for maintaining licensure and other information for healthcare facilities, onboarding new hires, and obtaining necessary...
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Medical Reviewer Nurse
6 days ago
Manila, National Capital Region, Philippines UST Full timeJob Summary:UST is seeking a qualified Medical Reviewer Nurse to join our team. As a key member of our healthcare team, you will play a critical role in ensuring the highest quality patient care while promoting efficient resource utilization.We are looking for a registered nurse with current, unrestricted US licensure and at least 3 years of direct, clinical...