PHRN Clinical Denials | Non-Voice | Healthcare BPO | Pasay

Access Healthcare is looking for REGISTERED NURSE to join our growing team.

You'll be ensuring the completion of assigned patient cases by doing roll calls, processing concurrent and retro clinical reviews, work processing surgery authorizations, as needed.

Responsibilities:

Perform advanced level work related to clinical denial and utilization management.

Manage medical denials by conducting a comprehensive review of clinical documentation.

Handle audit/compliance responsibilities and other administrative duties as required.

Write compelling arguments based on the clinical documentation and the medical policies of the payer and submit appeals in a timely manner.

Actively manage, maintain, and communicate denial or appeal activity to appropriate stakeholders and report suspected or emerging trends related to payer denials to Revenue Cycle management.

Qualifications:

Must be Registered Nurse with active license.

With 1-2 years hospital bedside/ acute care/ clinical setting experience.

Experience in healthcare BPO account is a definite advantage (Denials &Appeals, Utilization Review, Coding).

Amenable to work in Double Dragon, Pasay City.

Can start immediately.