Medical Necessity Specialist

About the RoleWe are seeking an experienced Medical Billing Specialist to join our team. As a Medical Billing Specialist, you will be responsible for reviewing appeals for medical necessity, faxing appeals to the appropriate party, and following up on appeals to ensure timely processing.ResponsibilitiesReview appeals for medical necessity and determine...

Utilization Management SpecialistWe are seeking a skilled Utilization Management Specialist to join our team.Job Description:Our ideal candidate will assess and interpret customer needs, requirements and medical records, reviewing medical claims for medical necessity.Key Responsibilities:Assess and interpret customer needs, requirements and medical...

Wound Care Specialist OpportunityOur organization specializes in recruiting and managing high-caliber remote staff for dynamic healthcare facilities.We are seeking a skilled Wound Care Specialist to manage patient wound care records, verify insurance eligibility, and coordinate the supply of essential medical materials.As a Wound Care Specialist, your...

Position: Medical Coder Location: 1880 Eastwood, Libis, Quezon City Work setup & shift: WFH | Night shiftYour Role: As an Medical Coder, you will: Assign accurate CPT, ICD-10-CM, and HCPCS codes for wound care procedures, including debridement, skin grafts, and negative pressure wound therapy (NPWT). Ensure full compliance with CMS, HIPAA, and...

Job TitleNurse - Oncology and Intensive Care Specialist Job OpportunityJob DescriptionWe are seeking a highly skilled and experienced Nurse to join our team as an Oncology and Intensive Care Specialist. In this role, you will be responsible for performing precertification, prior approvals, concurrent and retrospective reviews, and coordination of discharge...

Job Title: Clinical Authorization SpecialistWe are seeking a detail-oriented and highly skilled individual to support our clinical operations. The successful candidate will be responsible for conducting thorough reviews, case consultations, and interfacing with insurance payers to obtain continued authorization.The ideal candidate will be a licensed clinical...

OverviewPosition SummaryWe are seeking a highly skilled and detail-oriented Peer Review Specialist to support our Residential, PHP, and IOP levels of care. This individual will be responsible for conducting peer reviews, case consultations, and interfacing with insurance payers to obtain continued authorization. The ideal candidate will be a licensed...

Improve patient care by working as a Utilization Management specialist in a virtual environment.Key responsibilities include assessing and interpreting customer needs, requirements and medical records, as well as reviewing medical claims for medical necessity.Required skills and qualifications include:Active PHRN and USRN Mainland License1 year Bedside...

Job Title: Utilization Review SpecialistWe are seeking a skilled professional to assess and interpret customer needs, requirements, and medical records.Key Responsibilities:Assess and interpret customer needs, requirements, and medical records.Review medical claims for medical necessity, ensuring alignment with industry standards.Requirements include an...

Wound Care SpecialistWe are seeking a skilled professional to manage patient wound care records, verify insurance eligibility, and coordinate the supply of essential medical materials.This role is ideal for individuals who are passionate about wound care and eager to make a meaningful impact.Manage patient wound care records and verify insurance...