Utilization Reviewer

Discover your 100% YOU with MicroSourcingPosition:Utilization Review Nurse SpecialistLocation:TaguigWork setup & shift:Onsite | Night shiftWhy join MicroSourcing?You'll HaveCompetitive Rewards: Enjoy above-market compensation, healthcare coverage on day one, plus one or more dependents, paid time-off with cash conversion, group life insurance, and...

About the role As the Utilization Review Nurse Team Leader at Access Healthcare Services Manila, Inc.', you will play a pivotal role in leading and mentoring a team of Utilization Review Nurses. Based in the heart of Taguig City, Metro Manila, this full-time position offers opportunities for career growth and development within a dynamic healthcare...

Let your Passion Lead You at the Home of Clinicians with over 5000+ employees who have trusted us with their careersPhysical Sites: Taguig, Cebu, and Pampanga Our Clinicians & Associates advocates for better patient care while enjoying these benefits:PHP100,000 Sign-On Bonus (for selected accounts)Work from home until further notice (for selected...

The opportunityAccess Healthcare Services Manila, Inc. is seeking a highly motivated and experienced PHRN | Utilization Review Nurse Team Leader to join our dynamic team. As the PHRN | Utilization Review Nurse Team Leader, you will play a crucial role in driving the success of our Utilization Review Nursing operations within the broader Healthcare & Medical...

The Reviewer is responsible for assessing the delivery of medical services to determine if the care provided is appropriate, medically necessary, and of high quality. This includes examination of documents to see if patients are given care consistent with their needs as well as inputting of approved Guidelines and References. The review typically involves...

Job SummaryThe KYC Reviewer is responsible for accurately and efficiently reviewing player identity submissions to ensure compliance with KYC standards. This role focuses on verifying eligibility, name matching, and identifying suspicious or fraudulent activity while consistently meeting internal Service Level Agreement (SLA) and productivity targets.Key...

Responsibilities:Develop full understanding of each medical and claim payment policy, to ensure accurate diagnosis and procedure code assignment. Understand CMS/regulatory requirements, IBX/AH benefit structure, managed care rules (e.g., HMO Capitation, PPO Network Rules) and other business rules to assure diagnosis and procedure code alignmentReal-time...

1 OpeningTaguigRole descriptionDevelop full understanding of each medical and claim payment policy, to ensure accurate diagnosis and procedure code assignment. Understand CMS/regulatory requirements, IBX/AH benefit structure, managed care rules (e.g., HMO Capitation, PPO Network Rules) and other business rules to assure diagnosis and procedure code...

Discover your 100% YOU with MicroSourcingPosition:Utilization and Denials Management AuditorLocation:TaguigWork setup & shift:Onsite | Night shiftWhy join MicroSourcing?You'll HaveCompetitive Rewards: Enjoy above-market compensation, healthcare coverage on day one, plus one or more dependents, paid time-off with cash conversion, group life insurance, and...

Discover your 100% YOU with MicroSourcingPosition:Utilization & Denials Management SupervisorLocation:TaguigWork setup & shift:Onsite | Night shiftWhy join MicroSourcing?You'll HaveCompetitive Rewards: Enjoy above-market compensation, healthcare coverage on day one, plus one or more dependents, paid time-off with cash conversion, group life insurance, and...