Clinical Denials and Appeals Specialist (PHRN)

Philippines Job Openings

Gratitude Inc.

Taguig

FULL TIME

September 15, 2024

Gratitude Inc. is a leading professional HR Tech Recruitment firm specializing in recruiting permanent, contract, and temporary positions for the world's top companies. Our base is in India, Philippines, Malaysia, Kenya, Nigeria, Singapore, Vietnam, Thailand, and USA. We are a direct sourcing partner Company of the different top BPOs offshore and onshore.
We have an ongoing hiring for a Clinical Denials and Appeals Specialist for our Healthcare BPO Partner in Taguig. We are also in need of Team Leader and QAs for the Clinical Denials and Appeals.
COMPETENCIES, SKILLS AND OTHER REQUISITE:

Excellent written and spoken English
Unflinching integrity and personal work ethics
Self-starter who strives for self and team excellence
Flair for client satisfaction
Attention to detail and concern for accuracy
Excellent time management skills and multi-tasking ability
Excellent team player
Compliant to rules and regulations

ACADEMIC AND PROFESSIONAL BACKGROUND:

Academic qualification for this role is Registered Nurses
Knowledgeable in specific medical Inpatient and/or outpatient coding terminology and guidelines, not limited to but include – DRG, Diagnosis, CC, MCC, ICD 10 coding, CPT procedure coding, etc.
Working experience in MCG and Inter Qual criteria
Have prior experience working authorization and medical necessity denials

RESPONSIBILITIES:

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 Inter Qual 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 patients and medical record
Perform all other necessary steps on the specified accounts per the 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

COMPLIANCE:

Awareness and implementation of ISO, ISMS and GRIC policies
Adherence to the rules and regulations as outlined by the management.

ASSESSMENT / INTERVIEW PROCESS:
1. Personal Interview (HR)
2. Domain Panel Interview
3. HR Discussion
To apply, please submit your updated resume on this post or via email at isay@gratitudephilippines.com and answer the pre-screening questions.
Further details will be discussed once invited for an interview.
Our recruitment team will reach out to you via Whats App or direct call once shortlisted.
APPLY NOW!
Job Type: Full-time
Pay: Php35,000.00 - Php47,500.00 per month
Benefits:

Health insurance
Life insurance

Schedule:

Rotational shift

Supplemental Pay:

13th month salary
Overtime pay

Application Question(s):

How many years of Clinical Denials and Appeals experience do you have? (REQUIRED)
Are you a Registered nurse with an active license? (REQUIRED)
Are you amenable to working onsite at BGC Taguig and with rotational work schedule for our healthcare BPO Partner? (REQUIRED)
How much is your last drawn salary? (REQUIRED)
How much is your salary expectation? (REQUIRED)
When are you available to start? (REQUIRED)

We regret to inform you that this job opportunity is no longer available as it has expired

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