Operations Manager for Appeals - PHRN

Gratitude Inc

1668 Views

16 hours ago

1-2 Year(s)

₱ 120 - ₱ 150K p.m

Manila (Cubao Quezon City)

Job Description

Key Skills

Detail oriented Strong communication and interpersonal skills

1 candidate(s) have already applied for this Job. Apply now

LOB DESCRIPTION: Medical necessity review for appeals (Claims denied due to medical necessity)

JOB SUMMARY:

The Operations Manager for Appeals is responsible for managing and overseeing operations related to clinical appeals, ensuring compliance with industry standards and regulatory requirements. The role involves close collaboration with various stakeholders to drive performance and maintain high-quality standards.

QUALIFICATIONS:

• Bachelor’s Degree in Nursing with an active and valid license in PHRN
• Must have at least 1 or 2 years in a managerial role handling leaders/ TLs/ Supervisors
• Experience in managing teams handling Clinical Appeals
• Experience in handling appeals, utilization review, or related healthcare management functions
• Excellent verbal and written communication skills
• Willingness to work on-site with flexible schedules, including US hours and holidays
• Must not be a current or former employee of Concentrix

KEY RESPONSIBILITIES:

• Oversee daily operations and ensure compliance with SLAs and regulatory standards.
• Developer and implement process improvement initiatives.
• Collaborate with internal and client stakeholders to enhance service delivery and maintain accurate staffing.
• Ensure adherence to HIPAA and other regulatory requirements.

Role

Nurse

Timings

Night Shift (Permanent)

Industry

Health/Fitness/Wellness

Work Mode

Work from office

Functional Area

Medical Professional / Healthcare Practitioner / Technician

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