Clinical Denials and Appeals

Job Opportunity: Registered Nurse Bedside experienceWe are seeking Registered Nurses to become part of our expanding team. In this role, you will help ensure the timely completion of patient cases by conducting roll calls, processing concurrent and retrospective clinical reviews, and handling surgery authorizations when required.Key ResponsibilitiesPerform...

Position Summary - Responsible for Client operations including the execution of Clinical Denials. Also has overall responsibility for delivering on respective process metrics such as account cycle time and functions thereof, process cost and functions thereof, adherence to process standards, and process quality. This involves conducting continuous...

Position OverviewWe are seeking a Spanish Bilingual Team Lead with strong medical billing expertise to oversee a team handling healthcare claims, denials, and appeals. This role requires leadership skills, bilingual communication, and technical knowledge of billing processes to ensure accuracy, compliance, and efficiency in revenue cycle operations.Key...

Qualifications:Experience & EducationMinimum of 5+ years of combined experience in direct patient care and/or a clinical administrator role (e.g., utilization management, clinical authorizations, clinical denials, or clinical documentation integrity) with a solid track record in reputable organizations.Registered Nurse (RN) or hold another clinical patient...

Duties and responsibilitiesContact insurance carriers to verify patient's insurance eligibility, benefits and requirements.Request, track and obtain pre-authorization from insurance carriers within time allotted for medical and services.Review, request, follow up and secure authorizations for high dollar cost oncology chemotherapy drugs.Demonstrate and apply...

Join Access Healthcare Manila as aDRG Nurse Auditor. We are seeking talented individuals to join our team and help drive our success. Apply now and take the next step in your career today. We will provide free training on the client's medical billing software to perform this role.Tasks:Conduct initial audit reviews to validate billed diagnoses and DRG code...

Quality Auditor hiring Clinical Authorization Process.Onsite, Night Shift, Mon-FridayQualificationsMust hold an active PHRN license (not a USRN license holder)Relevant experience as a Quality Auditor in Clinical Services within a healthcare BPO environment; alternatively, 4 to 7 years of specialized experience in Clinical Authorization or Utilization Review...

Discover your 100% YOU with MicroSourcingPosition:Clinical Revenue Operations DirectorLocation: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...

We're Hiring: PHRN Quality Auditor Clinical Services Location: Onsite, Mckinley, Taguig Schedule: Night Shift | Monday to Friday Hiring Target Date: Preferably by July 21, 2025 Salary Range: Up to 50kQualifications Must hold an active PHRN license (Not a USRN holder) Prior experience as a Quality Auditor in a healthcare BPO clinical setting Alternatively, 4...

We are hiring for an experienced Medical Biller to join our growing U.S. healthcare team. In this role, you will manage the end-to-end Revenue Cycle Management process, ensuring timely and accurate claims submission, payment posting, AR follow-up, and denial management for our U.S. clients.This is a great opportunity for professionals with a solid background...