Healthcare Denials Management Nurse

3 days ago

Taguig, National Capital Region, Philippines Private Advertiser Full time

We are seeking a Registered Nurse to join our dynamic and growing team. In this role, you will ensure the completion of assigned patient cases through roll calls, concurrent and retrospective clinical reviews, and processing surgery authorizations as needed.

Key Responsibilities
  • Conduct advanced-level work related to clinical denials and utilization management.
  • Review clinical documentation thoroughly to manage medical denials.
  • Handle audit, compliance, and other administrative responsibilities.
  • Prepare and submit timely, well-supported appeals based on clinical documentation and payer medical policies.
  • Resolve charge discrepancies to ensure accurate billing, while guiding staff on proper billing, follow-up, and documentation practices.
  • Identify and correct errors in third-party payer reimbursement denials related to documentation, medical necessity, coding, modifiers, and other issues.
  • Monitor, maintain, and communicate denial and appeal activities to stakeholders, and report emerging trends to Revenue Cycle management.
Qualifications
  • Active license as a Registered Nurse.
  • Hospital bedside experience in OR, ER, ICU, PACU, General Wards, or Post-Surgery Care.
  • Background in BPO healthcare accounts is a strong advantage (Insurance, Denials & Appeals, Coding, Utilization Review, Prior Authorization, etc.).
  • Willingness to work onsite in Taguig.
  • Availability to start immediately.
Why Join Us?

We're looking for talented individuals like you to make a meaningful impact. Apply now and be part of our growing success

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