Utilization Review Nurse – Denials and Appeals

2 days ago

Pasay, National Capital Region, Philippines Access Healthcare Full time ₱420,000 - ₱540,000 per year

Job description:

Access Healthcare is looking for REGISTERED NURSE to join our growing team.

You'll be ensuring the completion of assigned patient cases by doing roll calls, processing concurrent and retro clinical reviews, work processing surgery authorizations, as needed.

Responsibilities :

  • Perform advanced level work related to clinical denial and utilization management.
  • Manage medical denials by conducting a comprehensive review of clinical documentation.
  • Handle audit/compliance responsibilities and other administrative duties as required.
  • Write compelling arguments based on the clinical documentation and the medical policies of the payer and submit appeals in a timely manner.
  • Resolve charge problems to ensure accurate and complete billing, and inform staff on proper billing, follow-up, and documentation practices.
  • Review and rectify errors in third party payer reimbursement denials based on documentation, billing accuracy, medical necessity, coding, modifier, and other related issues.
  • Actively manage, maintain, and communicate denial or appeal activity to appropriate stakeholders and report suspected or emerging trends related to payer denials to Revenue Cycle management.

*

Qualifications :

  • Must be Registered Nurse with Active license
  • Hospital Bedside experience (OR / ER / ICU/ PACU / General Wards / After Surgery Care )
  • Experience in BPO Healthcare account is a definite advantage (Insurance, Denials & Appeals, Coding, Utilization Review, Prior Authorization, ETC )
  • Must be amenable to work onsite at Double Dragon, Pasay
  • Can start ASAP

We need talented individual like you, Apply Now

Job Type: Full-time

Pay: Php40, Php45,000.00 per month

Benefits:

  • Additional leave
  • Health insurance
  • Life insurance
  • Opportunities for promotion
  • Pay raise
  • Promotion to permanent employee
  • Transportation service provided

Experience:

  • Registered Nurse: 1 year (Required)
  • BPO Agent: 1 year (Required)

License/Certification:

  • PHRN license (Required)
  • USRN license (Required)

Work Location: In person

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