Gratitude Inc banner
MyGlit Jobs |  Jobs |   Clinical Denials and Appeals in Mumbai & Delhi

Clinical Denials and Appeals

Gratitude Inc
151 Views
1 week ago

Clinical Denials and Appeals

2-4 Year(s)
10 - 15 Thousand p.m
Manila (Taguig)
Manila (Taguig)

Job Description

Key Skills

Clinical Denials and appeals

Be the first to apply for this job. Apply now

Job title: PHRN – Clinical Denials and Appeals



Work set up: Onsite Opportunity – MCK Taguig, Cyber Sigma Building



Work schedule :Weekdays Night Shift schedule, Fixed Weekends Off



Salary: 45K to 50K salary package



HC:5



One day hiring process – our calendar flexible for interview any time on Monday onwards



Must be willing to start on or before May 19



Job Description



-Effectively review inpatient and/or outpatient medical necessity and authorization denials to determine and understand the validity of such denials in a timely manner --Should conduct comprehensive reviews of the claim denial and account, to make determinations of what action to be taken to obtain reimbursement.



-Utilize payer policies, MCG and InterQual criteria to determine if account meets criteria for appeal



-Should write an appeal letter to payer using appropriate clinical indicators, citing Official Coding Guidelines, and documentation from within the patient’s medical record



-Perform all other necessary steps on the specified accounts per Clients SOP’s including documentation in the EMR, including appeal package creation Manage the accounts until payment is received, the account is written-off, transferred to patient-liability, or other adjudication / movement within the system that is appropriate and agreed upon by both Parties



-Reporting quality results, tracking and trending of educational opportunities of the coding and CDI specialists, responding to client subject matter needs, and providing educational support and training



Qualifications:



-PH Registered Nurse with experience in doing medical necessity appeals, lack of authorization appeals.(6 months needed)



-Proficient in reading Explanation of Benefits (EOB) and investigating denial root causes.



-Must be skilled in navigating various payer and provider portals.



-Typing speed of at least 45 WPM.



-Strong command of the English language, both spoken and written.



-Willing to work night shifts to communicate with payers.



-Familiarity with MCG and InterQual is a plus.



-Must NOT hold a USRN license

Role

Nurse

Timings

Day Shift (Permanent)

Industry

Medical / Healthcare / Hospital

Work Mode

Work from office

Functional Area

Medical Professional / Healthcare Practitioner / Technician

Note: Myglit doesn't charge any money from candidates. If you have been asked to pay money to get this job then report to us immediately at support@myglit.com.

MyGlit Jobs |  Jobs |   Clinical Denials and Appeals in Mumbai & Delhi

Esther Adesoye

Recruiter - Gratitude Inc

NA, nigeria

0+ Followers

500+ Posts

Interview Tips

  • Giving the VNA round?
  • What are the most important skills you acquired as a Soft Skills/VNA trainer?
  • How would you handle an irate customer?

Get the Best Jobs
on your Fingertips

Similar Jobs

1 - 3 Year(s)

Insurance Skills Healthcare Experience

10 - 15 Thousand p.m

Manila, Philippines

5 - 7 Year(s)

Bio Medical engineering

100 - 110 Thousand p.m

Manila, Philippines

3 - 4 Year(s)

coding medical coding

10 - 15 Thousand p.m

Manila, Philippines

1 - 3 Year(s)

coding

60 - 65 Thousand p.m

Manila, Philippines

5 - 7 Year(s)

Medical Doctor Designing and implementing psychological, health, and financial wellness programs Wellness Manager

100 - 110 Thousand p.m

Manila, Philippines

0 - 1 Year(s)

PHRN lack of authorization appeals investigating denial root causes

10 - 50 Thousand p.m

Manila, Philippines

1 - 2 Year(s)

PHRN Active PRC license

10 - 15 Thousand p.m

Manila, Philippines

1 - 2 Year(s)

Customer Service

10 - 15 Thousand p.m

Manila, Philippines

5 - 7 Year(s)

Medical Doctor

10 - 15 Thousand p.m

Manila, Philippines

MyGlit Jobs |  Jobs |   Corporate Trainer in Mumbai & Delhi

Corporate Trainer

Gratitude Inc

2 - 3 Year(s)

BPO Skills .Trainer

10 - 15 Thousand p.m

Cebu Central Visayas, Philippines