Gratitude Inc banner
MyGlit Jobs |  Jobs |   PHRN – Clinical Denials and Appeals-VERY URGENT in Mumbai & Delhi

PHRN – Clinical Denials and Appeals-VERY URGENT

Gratitude Inc
133 Views
1 week ago

PHRN – Clinical Denials and Appeals-VERY URGENT

0-1 Year(s)
45 - 50 Thousand p.m
Manila (Taguig)
Manila (Taguig)

Job Description

Key Skills

PHRN lack of authorization appeals investigating denial root causes typing speed test Proficient in reading Explanation of Benefits (EOB)

Be the first to apply for this job. Apply now

One day hiring process – our calendar is flexible for interviews anytime on Monday onwards.



Job Description




  • Effectively review inpatient and/or outpatient medical necessity and authorization denials to determine and understand the validity of such denials promptly

  • Should conduct comprehensive reviews of the claim denial and account to make determinations of what action to take to obtain reimbursement.

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

  • Should write an appeal letter to the 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 Client SOP’s SOPs, 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 and 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

Dental

Timings

Night Shift (Permanent)

Industry

BPO

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 |   PHRN – Clinical Denials and Appeals-VERY URGENT in Mumbai & Delhi

Mikail Shehu

Recruiter - Gratitude Inc

NA, nigeria

1+ 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 - 2 Year(s)

Troubleshooting Communication Skills Technical Skills

Confidential

Manila, Philippines

MyGlit Jobs |  Jobs |   Project Manager in Mumbai & Delhi

Project Manager

Gratitude Inc

5 - 10 Year(s)

Project management Project Manager

80 - 110 Thousand p.m

Manila, Philippines

4 - 5 Year(s)

GDS Experience

30 - 40 Thousand p.m

Manila, Philippines

0 - 14 Year(s)

Inbound BPO BPO Voice Process BPO Skills

20 - 25 Thousand p.m

Manila, Philippines

0 - 9 Year(s)

Call Center Inbound BPO BPO Voice Process

20 - 35 Thousand p.m

Manila, Philippines

1 - 3 Year(s)

Voice & Accent

30 - 40 Thousand p.m

Manila, Philippines

1 - 3 Year(s)

Insurance Skills Healthcare Experience

10 - 15 Thousand p.m

Manila, Philippines

3 - 5 Year(s)

Business Continuity

Confidential

Manila, Philippines

1 - 2 Year(s)

Bilingualism

95 - 100 Thousand p.m

Manila, Philippines

1 - 15 Year(s)

Inbound BPO BPO Voice Process BPO Skills

20 - 30 Thousand p.m

Manila, Philippines