Clinical Appeals Specialist

Clinical Appeals Specialist (Registered Nurse)Our partner in the BPO industry is looking for Clinical Appeals Writers to help navigate the complexities of medical claim denials and ensure fair resolutions for patients and providers.100% Remote – Work from anywhereDay Shift Hours – Enjoy a consistent scheduleWhat You'll Do:Prepare and Submit Clinical...

Overview:Omega Healthcare Management Services Inc. is seeking a highly skilled Appeals Nurse Specialist - Interqual Expert to join our team. The successful candidate will have experience in reviewing denied claims and determining the validity of denials.The ideal candidate will have a strong understanding of medical necessity and billing procedures, as well...

JOB SUMMARYResponsible for validating dispute reasons following Explanation of Benefits (EOB) review, escalating payment variance trends or issues to NIC management, and generating appeals for denied or underpaid claims.ESSENTIAL DUTIES AND RESPONSIBILITIESValidate denial reasons and ensure coding in DCM is accurate and reflects the denial reasons....

Access Healthcare is looking for a Utilization and Clinical Denials Nurse to join our growing clinical account. The ideal candidate is a Licensed Philippines Nurse with at least one (1) year of hospital bedside experience and a strong understanding of utilization review, clinical documentation, and denial management in a BPO set-up. This role involves...

About the Role:The Clinical Utilization Review Specialist will be responsible for conducting retrospective, concurrent, and prospective reviews of inpatient, outpatient, ambulatory, and ancillary services to ensure medical necessity, appropriate length of stay, intensity of service, and level of care.This role will also involve reviewing and researching...

Job Profile: Clinical Site Payment SpecialistPosition Summary: The Clinical Site Payment Specialist is responsible for ensuring timely and accurate payment processes for clinical trial sites. This role involves coordination with various stakeholders, including clinical research organizations (CROs), sponsors, and site personnel, to manage financial...

PRODUCT & CLINICAL SPECIALIST (MEDICAL IMAGING)QUALIFICATIONSMedical Allied graduate – must be licensed radiologic technologist.Minimum of 3 years of clinical experience as a general imaging or sonographer with experience in commercial clinical sales.Sales experience in the healthcare industry is a plus.Clinical product specialist include a bachelor's...

KMC Solutions is a leading provider of innovative healthcare solutions. We are seeking a Clinical Support Specialist to join our team as a RN. In this role, you will be responsible for providing clinical support to patients with chronic conditions.As a Clinical Support Specialist, you will develop and implement personalized care plans, conduct routine...

We are currently seeking a Clinical Analyst to support a growing client base while combining their clinical and/or coding expertise with payment accuracy. The Clinical Analyst is responsible for analyzing, interpreting, and assigning the correct codes for the descriptions available on various medical procedures and diagnoses, as well as other related medical...

Job SummaryThe Quality Assurance (QA) Specialist is a key administrative role crucial to the management and general business operations of our organization. This position necessitates a high degree of discretion and independent judgment, particularly in ensuring adherence to best practice standards and regulatory requirements. Tasked with auditing,...

Job Summary:We are seeking an experienced Clinical Documentation Improvement (CDI) Specialist to join our team at GGIS Services. The successful candidate will possess a strong understanding of US CDI practices and have expertise in crafting queries, understanding the US healthcare system, and demonstrating excellent communication skills.Main...

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. Our team plays a vital role in improving health outcomes by connecting individuals with the care, pharmacy benefits, data and resources they need to thrive. As a Clinical Utilization Specialist, you will join a diverse and inclusive culture...

Job OverviewVXI Global Holdings B.V. (Philippines) is seeking a highly skilled and compassionate Clinical Triage Specialist to join our team. As a key member of our healthcare access team, you will play a vital role in providing exceptional patient care and support.

Job Title: Clinical Coding and Compliance SpecialistWe are seeking a highly skilled Clinical Coding and Compliance Specialist to join our team at Harwood Global. This role offers the chance to utilize your expertise in medical coding and compliance to drive business excellence and growth.Key Responsibilities:Develop and implement clinical coding standards to...

Job Title: Clinical Documentation SpecialistThe Theoria Medical Quality Department is seeking a skilled Clinical Documentation Specialist to support its billing department by accurately reviewing, assigning, and verifying medical codes for various patient services.Responsibilities:Review and analyze medical records and documentation to ensure accurate...

Job SummaryTenet Global Business Center, Inc. is seeking a highly skilled Clinical Data Specialist to join our team. As a key member of our quality initiatives, this role will support the collection and analysis of patient data from electronic medical records.Essential Duties and ResponsibilitiesData Collection: Collect specific data elements from patient...

Clinical Revenue Cycle Associate needed at Care Solutions and Outsourcing Corp. to manage claims for a chain of pediatrics clinics in the USA. As a medical biller, your tasks will include processing claims, ensuring timely payments, investigating denied claims, and resubmitting corrected claims.Major Responsibilities:Claim processing and payment...

About the Role:This is an exciting opportunity for a Registered Nurse to join our team at Access Healthcare Services and contribute to the efficient management of patient care.The successful candidate will be responsible for performing advanced level work related to clinical denial and utilization management, including managing medical denials, handling...

Clinical Application Specialist - Radiologic TechnologistJoin to apply for the Clinical Application Specialist - Radiologic Technologist role at Pacific Surgical, Inc.Pacific Surgical Inc.Pacific Surgical was founded in 2005 as a medical device and equipment distributor focused on providing Filipino patients and surgeons with access to the best possible...

We are looking for a skilled Pediatrics Clinic Billing Professional to join our team at Care Solutions and Outsourcing Corp.. In this role, you will be responsible for processing claims for a chain of pediatrics clinics in the USA. Your primary goal will be to ensure timely payments from insurance companies and investigate any denied...