
PHRN – Clinical Denials and Appeals-VERY URGENT
Job Description
Key Skills
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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.

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?
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