Clinical Appeals Nurse Specialist - 30,000 BONUS - PHRN License - Start ASAP
Clinical Appeals Nurse Specialist - 30, 000 BONUS - PHRN License - Start ASAP
Nursing - General Medical & Surgical (Healthcare & Medical)
- At least 1 year experience on handling clinical analyst, UMR or prior authorization in a BPO set up
- PHRN License
- Willing to work onsite in Ortigas
- Can start ASAP
Job Description:
• Access account from appropriate work queue and mark account worked to make sure it will not be assigned to another reviewer
• Review activity summary, documentation, and correspondence to obtain notes related to the denial
o Review for additional information, such as insurance card, face sheet, detailed bill, Explanation Of Benefits, UB04, auth approval, denial letter
• Review claim and billing history to isolate any denials related to coding, billing, timely filing, missing or incorrect information
• Identify root cause of the denial
• Work on Medical Necessity and No Authorization denials , and Untimely filing only
• Review medical records and obtain necessary information to support medical necessity
o ER, H&P, Physician Orders, Consulatations, Operative Report, Coding Summary, Discharge Summary, Labs, Radiology, MAR, Outside Medical Records, Nurses Notes
• Apply contract language, benefits and covered services in researching and deciding the outcome of appeals
• Upload and send the letter to the correct fax number/address or Portal
• Document activity in the client systems
Your application will include the following questions:
What's your expected monthly basic salary?
How many years' experience do you have as a Nurse Specialist?
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