Clinical Denials Specialist
4 days ago
Clinical Denial Representative is responsible to review patient's medical claim when resolving edits for compliance (prior billing) and issues on rejections(rejected by the payor) in the physician side. Clinical Denial Representative must understand and comply with federal and state coding and billing regulation. The Clinical Denial Representative must ensure the confidentiality and privacy of information.
Key Responsibilities
Prepare and process accounts timely and accurately based on client requirement.
Review daily account/edit reports from work queues and/or in external billing software
and makes necessary corrections or resolve edits to allow electronic submission.
- a. Resolving edits prior billing (Compliance)
b. Resolving rejections from the payor (Rejection)
Reviews and make appropriate actions such as but not limited to:
a. Medical Necessity edits,
- b. Local Coverage Determination (LCD) and National Coverage Determination (NCD)
- edits
- c. National Correct Coding Initiative (NCCI) edits
- d. Modifier edits
- e. Payer specific edits
- f. Medically Unlikely Edits (MUE)
- g. Procedure to Procedure (PTP) edits
h. Diagnosis issue
Enter appropriate account notes into the billing system to clarify actions taken to
reconcile claims.
Maintains confidentiality of patient records at all times Observes HIPAA compliance.
Perform as a team player.
Use logic, critical thinking and reasoning to identify the strengths and weaknesses of
alternative solutions to problems.
- Understand the effects of new information for both current and future problem-solving
and decision-making.
High attention to detail
Attendance in accordance with company HR and department policies
Other tasks/functions that may be assigned by the company as per business
requirement; these may change from time to time to reflect the changing requirement
of your position and our business
Qualifications:
- Bachelor of Science in Nursing or Medical Allied Health Course.
- Preferred experience in revenue cycle (medical coding), knowledge of ICD-10, CPT procedures, and clinical or hospital settings.
- Certification required: AAPC (CPC, COC, CIC) or AHIMA (CCA, CCS-P, CCS).
- Willingness to work on temporary work from home set-up.
Job Type: Full-time
Benefits:
- Paid training
Work Location: Remote
-
Billing Denials Management Specialist
1 week ago
Work from Home, Philippines RML-PH Full time ₱400,000 - ₱600,000 per yearBilling Denials Management Specialist Location: Remote Department: Billing Reports To: Denial Billing Team Lad Salary: 35, ,000 phpAbout Us:RML-PH is a dynamic and innovative Health Solutions and Care Delivery Organization committed to transforming the healthcare landscape. With a mission to provide accessible, high-quality healthcare services and...
-
Clinical Appeal Nurse
4 days ago
Work from Home, Philippines Coronis Health LLC Full time ₱900,000 - ₱1,200,000 per yearClinical Appeals Specialist is responsible in writing a compelling and effective appeal based on the clinical Documentation, payer-specific policies and is compliant to Federal and State policies. The Clinical Appeals Specialist is responsible for appeals and follow-up on clinical denials, providing appropriate denial information to be submitted to...
-
Coding Denials Specialist
4 days ago
Work from Home, Philippines Coronis Health LLC Full timeCoding Denials Representative is responsible to review payor's denial and identify the root cause of the denials account. Coding Denial Representative determines if the account is appealable or not. Coding Denial Representative must understand and comply with the process established by the Federal and State regulations, Payor's specific guidelines, Official...
-
Clinical Appeals Nurse
2 days ago
Work from Home, Philippines Coronis Health LLC Full time ₱1,200,000 - ₱2,400,000 per yearJOB SUMMARY:The Clinical Appeals Nurse is responsible for creating a convincing and effective appeal based on clinical documentation, payer-specific standards, and compliance with federal and state policies. The Clinical Appeals Nurse is responsible for clinical denial appeals and follow-up, providing appropriate denial information to departments to ensure...
-
clinical coordinators
1 week ago
Work from Home, Philippines Cliniqon Full time ₱720,000 - ₱960,000 per yearClinical Coordination for Open ItemsObjective:Ensure timely resolution of clinical documentation and QA-related open items to support compliance, operational efficiency, and downstream processes.Proposal:Hire 1 Full-Time Employee (FTE) for a Clinical Coordinator role dedicated to managing open clinical items.Key Responsibilities:Run a standardized weekly...
-
Revenue Cycle Specialist
2 weeks ago
Work from Home, Philippines The Perfect Child LLC Full time ₱72,000 - ₱144,000 per yearPosition SummaryRevenue Cycle Management team is a critical role within The Perfect Child ABA company's Revenue Cycle team, responsible for overseeing the resolution of denied, underpaid, or misprocessed claims. This individual ensures accurate and timely reprocessing through expert analysis, effective communication, and proactive escalation when necessary....
-
Authorizations Specialist
4 days ago
Work from Home, Philippines The Perfect Child LLC Full time ₱900,000 - ₱1,200,000 per yearWe are seeking a detail-oriented and dependable Authorizations Specialist to join our healthcare management team. The ideal candidate will be responsible for obtaining, tracking, and verifying insurance authorizations for medical services, ensuring timely approvals and compliance with payer requirements. This role is critical to supporting patient access to...
-
Clinical Lead Generation Specialist
4 days ago
Work from Home, Philippines Ferry Health Full timeLocation: Remote (Philippines)Schedule: Monday–Friday, 9:00 AM – 5:00 PM ESTCompensation: ₱35,000–₱45,000 base salary, plus monthly performance incentivesEmployment Type: Full-time contractor (40 hours weekly)About Ferry HealthFerry Health is a U.S.-based healthcare startup helping patients navigate the world of medical practices, providers, and...
-
Home Health Quality Assurance Specialist
2 days ago
Work from Home, Philippines Narrable Full time ₱108 - ₱627 per yearAbout NarrableAt Narrable, we're on a mission to improve healthcare for the 82 million senior patients in their homes. As more Americans age, the demand for more convenient forms of healthcare continues to grow—with a majority of senior Americans preferring at-home treatment. And yet, existing software solutions for care providers are outdated and...
-
CDI Specialist
2 weeks ago
Work from Home, Philippines Coronis Health LLC Full time ₱40,000 - ₱80,000 per yearClinical Documentation Specialist is responsible to oversee the facility's medical recordkeeping practices. In this role, Clinical Documentation Specialist is responsible for ensuring that clinical documentation complies with federal laws, provide feedback in medical recordkeeping practices, andanalyzing medical information.RESPONSIBILITIES:Applying...