Clinical Denials and Appeals
Gratitude IncClinical Denials and Appeals
Job Description
Key Skills
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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.
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