Clinical Appeals Writer - (Registered Nurse)

Industry Category	Healthcare	Position	Practitioner / Medical Asst
Recruitment Department		Number Of Recruits	several
Work Location	Metro Manila (NCR) Taguig	Nature Of Work	Full Time
Gender Requirements	Male	Marriage Requirement	No marital status restrictions
Education Level	Open to all levels	Work Experience	No work experience restrictions
Age Requirement	Above 18 years old	Salary Package	Negotiable
Updated Date	2022-09-28	Valid Until	Valid for a long time

COMPANY BENEFITS:HMO with FREE 3 DependentsGroup Life Insurance coveragePaid Time-off credits of up to 20 days in a year10% Annual Performance based incentive

Location: Taguig, BGC

Shift: Morning Shift Schedule (6 AM - 3PM)

Work Arrangement: Onsite

Job Description

The Clinical Appeals Reviewer/Clinical Denials Clinician for the Appellate Solution is responsible for:

a) Recovering revenue associated with disputed/denied clinical claims or those eligible for clinical review

b) Preparing and documenting appeal based on industry accepted criteria.

Responsibilities and Duties

- Performs retrospective (post-discharge/ post-service) medical necessity reviews to determine appellate potential of clinical disputes/denials or those eligible for clinical review.

- Constructs and documents a succinct and fact based clinical case to support appeal utilizing appropriate module of InterQual® criteria (Acute, Procedures, etc). If clinical review does not meet IQ criteria, other pertinent clinical facts are utilized to support the appeal. Pertinent clinical facts include, but are not limited to, documentation preventing a safe transfer/discharge or documentation of medical necessary services denied for no authorization.

- Demonstrates ability to critically think, problem solve and make independent decisions supporting the clinical appellate process.

- Demonstrates proficiency in use of medical necessity criteria sets,MCG and InterQual®, as evidenced by Inter-rater reliability studies and other QA audits.

- Demonstrates proficiency in utilization of electronic tools including but not limited to ACE, MedAssets (formerly IMaCs) Authorization log, InterQual®, VI, HPF, as well as competency in Microsoft Office.

- Demonstrates basic patient accounting knowledge i.e. UB92/UB04 and EOB components, adjustments, credits, debits, balance due, patient liability, etc.

A leading fortune 500 Hospital and Healthcare company just opened it's Philippine office in Bonifacio Global City, Taguig. Be part of the pioneer shared services team and make a positive impact to the community.We are a community built on care. Our caregivers and supporting staff extend compassion to those in need, helping to improve the health and well-being of those we serve, and provide comfort and healing. Your community is our community.Our company is a healthcare services company headquartered in Dallas, Texas. We operate 65 hospitals and approximately 500 other healthcare facilities across the US. The company is listed in the NYSE.