Senior Clinical Appeals Specialist

1 day ago

Makati City, National Capital Region, Philippines beBeeClinical Full time ₱800,000 - ₱1,200,000

Transforming health outcomes requires a dedicated professional who can deliver clinical support for performing in-depth reviews of appeals. This role also involves reviewing quality of service issues, ensuring compliance with state and federally mandated turn-around-times and process requirements.

  • Deliver high-quality clinical support for the review of appeals, adhering to regulatory guidelines
  • Conduct thorough reviews of quality of service issues, identifying areas for improvement

The ideal candidate will possess excellent communication skills, both orally and in writing, as well as solid medical/clinical knowledge to interpret available medical information. A strong background in critical care experience is essential, along with a proven track record of interpreting complex medical data. The ability to work onsite is also required.

Key Responsibilities:

  • Appeal Review: Conduct detailed reviews of appeals, analyzing relevant medical information and applying clinical judgment to inform decision-making
  • Quality of Service: Identify and address areas for improvement in quality of service, working closely with stakeholders to implement changes

Required Qualifications:

  • Active licensure as a PH Registered Nurse
  • Minimum 3 years of critical care experience
  • Excellent communication and interpersonal skills
  • Strong analytical and problem-solving abilities

At our organization, we are committed to creating a culture that values diversity, equity, and inclusion. We believe that every individual deserves the opportunity to thrive and contribute their unique perspective and skills. Join us in our mission to improve health outcomes and advance healthcare innovation.

Benefits:

  • Career Development Opportunities: Engage in ongoing education and training to enhance your skills and advance your career
  • Diverse Work Environment: Collaborate with a talented team of professionals from diverse backgrounds and industries
  • Comprehensive Benefits Package: Enjoy a range of benefits, including health insurance, retirement savings plans, and paid time off

Equal Employment Opportunity: We are an equal opportunity employer, committed to fostering a workplace that is inclusive and respectful of all individuals. We welcome applications from candidates of all backgrounds and perspectives.

  • Healthcare Professional

    3 days ago

    Quezon City, National Capital Region, Philippines beBeeClinical Full time ₱800,000 - ₱1,200,000

    Job SummaryClinical Appeal Specialist role available in a dynamic BPO setting.Key ResponsibilitiesAssist with medical necessity reviews and interpretation of clinical documentation.Collaborate with cross-functional teams to ensure accurate and timely appeal resolutions.RequirementsActive PHRN license holder required.Minimum 1 year of clinical experience in...

  • Clinical Insurance Specialist

    3 days ago

    Quezon City, National Capital Region, Philippines beBeeInsurance Full time ₱350,000 - ₱550,000

    Job TitleClinical Insurance SpecialistA clinical insurance specialist performs intermediate level insurance verification and authorization duties with a growing level of responsibility. The position coordinates with clinical departments to ensure accurate scheduling for covered services, resolves moderate issues with payers, and supports pre-visit readiness...

  • Therapeutic Franchise Head

    4 days ago

    Makati City, National Capital Region, Philippines Emerald Clinical Full time

    OverviewJoin to apply for the Therapeutic Franchise Head (Renal) role at Emerald Clinical.At Emerald Clinical Trials, we are a global, full-service Contract Research Organization (CRO) with a rich heritage in the Asia-Pacific region. We are dedicated to advancing clinical research through scientific expertise and operational excellence, supporting...

  • Clinical Medical Expert

    4 days ago

    Makati City, National Capital Region, Philippines beBeeConsultant Full time $80,000 - $120,000

    Medical Consultancy PositionClinical professionals with expertise in medical expense management are required to advise leadership on improvement opportunities.Provides strategic guidance to senior level professional staff and managers.Focuses on operational or local business unit or market level impact.Owning end-to-end processes is essential.Develops...

  • Clinic Administrative Associate

    2 days ago

    Makati City, National Capital Region, Philippines The Medical City Full time

    OverviewClinic Administrative Associate - TMC Clinic (Waltermart Makati)Responsible for administrative support in a clinical setting, including patient reception, scheduling, records management, and coordination with HMOs and stakeholders.ResponsibilitiesAssists in the performance of needed medical and diagnostic proceduresGreets and assists patients as soon...

  • Clinic Administrative Associate

    15 hours ago

    Makati City, National Capital Region, Philippines The Medical City Full time

    Overview Clinic Administrative Associate - TMC Clinic (Waltermart Makati) Responsible for administrative support in a clinical setting, including patient reception, scheduling, records management, and coordination with HMOs and stakeholders. Responsibilities Assists in the performance of needed medical and diagnostic procedures Greets and assists...

  • Clinical Support Professional

    9 hours ago

    Makati City, National Capital Region, Philippines beBeeAdministrative Full time ₱2,000 - ₱3,000

    Job Title:Clinic Administrative AssociateJob Description:Responsible for administrative support in a clinical setting, including patient reception, scheduling, records management, and coordination with healthcare stakeholders.Responsibilities:Assists in the performance of medical procedures and diagnostic tests.Greets and assists patients upon arrival at the...

  • Clinical Quality Specialist

    5 days ago

    Quezon City, National Capital Region, Philippines beBeeHealthcareQualityAnalyst Full time ₱900,000 - ₱1,200,000

    Clinical Quality ProfessionalWe are seeking a Clinical Quality Professional to join our team. This role is responsible for ensuring the quality of clinical services provided to our customers.In this position, you will be responsible for evaluating and analyzing clinical data to identify areas for improvement. You will also be involved in the development and...

  • Clinical Operations Specialist

    3 days ago

    Mandaluyong City, National Capital Region, Philippines beBeeClinical Full time ₱25,000 - ₱50,000

    Clinical CoordinatorWe are seeking a skilled and experienced Clinical Coordinator to join our team. In this role, you will be responsible for ensuring the smooth coordination of clinical activities and providing exceptional support to our clients.Coordinate daily clinical activities, including admissions, discharges, and transfers;Gather and enter patient...

  • Training Expert

    2 days ago

    Makati City, National Capital Region, Philippines beBeeOpportunity Full time ₱800,000 - ₱1,200,000

    Job Description:">As a Senior Trainer, you will be responsible for the successful implementation and management of the training department. This includes delivering training programs to employees using various methods such as classroom instruction, e-learning, and on-the-job training. You will also review training needs and performance on a monthly basis,...