Qualifications:
At least 1 year Clinical (bedside) experienceAt least a year revenue cycle management experiencewith background in Clinical Appeals, InterQual Reviews and MCGWilling to work o
nsiteWilling to work in BGCShift: 6:00AM-3:00PM
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.Co
nstructs and docu
ments a succinct and fact ba
sed 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, docu
mentation preventing a safe transfer/discharge or docu
mentation of medical necessary services denied for no authorization.Demo
nstrates ability to critically think, problem solve and make independent decisions supporting the clinical appellate process.Demo
nstrates proficiency in use of medical necessity criteria sets,MCG and InterQual®, as evidenced by Inter-rater reliability studies and other QA audits.
Why join us?
Job Types: Full-time, Permanent Plus, Allowances and 15%-night differentialHMO upon hire plus 1 dependent Additio
nal 2 HMO dependents upon regularization Group life insuranceCOVID-19 considerations: work set up
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.