PHRN - Clinical Denials and Appeals

Work set up: Onsite Opportunity – MCK Taguig, Cyber Sigma Building

Work schedule: Weekdays Night Shift schedule, Fixed Weekends Off

Responsibilities

• Effectively review inpatient and/or outpatient medical necessity and authorization denials to determine and understand the validity of such denials in a timely manner -- Should conduct comprehensive reviews of the claim denial and account, to make determinations of what action to be taken to obtain reimbursement.
• Utilize payer policies, MCG and InterQual criteria to determine if account meets criteria for appeal
• Should write an appeal letter to payer using appropriate clinical indicators, citing Official Coding Guidelines, and documentation from within the patient's medical record
• Perform all other necessary steps on the specified accounts per Clients SOP’s including documentation in the EMR, including appeal package creation
• Manage the accounts until payment is received...