PHRN Clinical Denials and Appeals Nurse

Qualifications

At least 1 year of relevant BPO experience as a Clinical Denials and Appeals Nurse

Minimum of 6 months hospital experience

PHRN license

Willing to report onsite (McKinley West, Taguig) and on a night shift schedule

Responsibilities

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

What We Offer

Excellent Company Culture

Day 1 Health Insurance, plus free dependent

Fixed schedule and fixed weekends off

Non-Toxic | Blended Non-Voice Account

Employee Referral Incentive

Opportunity for promotion

About Us

We are an analytics-driven, technology-enabled revenue cycle management company that alleviates financial and administrative burdens on healthcare providers by providing billing, coding, automation and analytics services.