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 Utilization Reviewer Specialist for our Healthcare BPO Partner in Taguig. We are also in need of Team Leader and QAs for the Utilization Review.
Position: Utilization Reviewer Specialist
Location: BGC, Taguig and onsite
Salary: Upto Php47,500 depending upon overall experience
Job Type: Permanent
Shifts: Rotational
No. of opening: 5
COMPETENCIES, SKILLS AND OTHER REQUISITES:

• 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 with rules and regulations

ACADEMIC AND PROFESSIONAL BACKGROUND:

• With relevant experience as a Utilization Reviewer
• Academic qualification for this role is a graduate in Nursing.
• Required Certifications/Licensure Registered Nurse currently licensed

COMPLIANCE

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

RESPONSIBILITIES:

• Provide health care utilization review services regarding admissions, observations, Discharge Wqs based on the payer types and review types.
• Review admissions and service requests within assigned unit for prospective, concurrent, and retrospective medical necessity and/or compliance with reimbursement policy criteria.
• Assist with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals.
• Notifies attending physician and other members of the health care team of inappropriate admissions, denials, end of authorized days, or other factors that have a reimbursement impact.
• Consults with attending physician when documentation in the medical record does not support admission or continued stay and seeks to ensure completeness of all clinical documentation.
• Functions as liaison between the Physician Advisor and the attending physician.
• Documents denial information in electronic medical record system including attempts at resolution/overturning of the denial.
• Provides all payor communication to be scanned into the system for use in appeals.
• Application of MCG and Inter Qual guidelines for each case review to determine the status.
• Consults with medical and treatment staff regarding client diagnosis, medical justification, length of treatment, and case documentation.
• Participates in utilization and peer review meetings and projects.

COMPENSATION AND BENEFITS:

• Competitive remuneration + annual performance-based bonus +standard industry benefits. Relocation package, per company policy will apply to candidates outside the office base city.

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
Schedule:

• Rotational shift

Application Question(s):

• How many years of Utilization Review 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)