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    Clinical Appeals Nurse Specialist - España - Nezda Technologies

    Nezda Technologies
    Nezda Technologies España

    hace 1 semana

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    Descripción
    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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