Medical Billing and Appeals Specialist

The Clinical Appeals Specialist (PHRN) is Responsible for the Review, Processing, and Resolution of Appeal(s) Case(s) in Compliance with NCQA and if Applicable, CMS Regulatory Standard(s) and Client Specific Guideline(s). · ...

This role involves handling prior authorization, appeals, and ARs in a healthcare account with a Registered Nurse (PHRN) license. · ...

Review inpatient medical records to validate principal diagnosis secondary diagnoses procedures and DRG assignment. · ...

+PHRN - Prior Auth/Appeals/AR role with BPO experience in a healthcare account and Registered Nurse (PHRN) license required. Can start in January. · +BPO experience in a healthcare account · +Registered Nurse (PHRN) license · ...

This position is responsible for reviewing inpatient medical records to validate principal diagnosis, secondary diagnoses (CC/MCC), procedures and DRG assignment. · The specialist will analyze payer denials involving DRG downgrades, removal of CC/MCC and clinical validation denia ...

The DRG Appeals Specialist will review medical records to validate diagnoses, procedures, and DRG assignment. They will analyze payer denials, prepare appeal letters supported by guidelines and industry references, defend secondary diagnoses assignments based on provider document ...

Hello! Are you looking for a challenging role that combines your passion for education and healthcare? · We have an exciting opportunity for a Denials & Appeals Education Specialist to join our team at MicroSourcing! · You will be responsible for delivering end-to-end process tra ...

We are looking for a Medical Billing & Appeals Specialist to assist with appeals submission for denied claims and support day-to-day billing operations. · ...

We are looking for a Denials & Appeals Compliance Specialist to support our QA program build by identifying key audit areas, critical workflow aspects, and automation opportunities to enhance efficiency. · ...

The Claims Resolutions Specialist prepares and submits appeals for denied claims using payer guidelines contracts fee schedules and medical records to resolve issues trigger payments address complex denial scenarios investigate discrepancies between expected actual payments evalu ...

The Clinical Appeals Specialist is Responsible for the Review, Processing, and Resolution of Appeal(s) Case(s) in Compliance with NCQA and if Applicable, CMS Regulatory Standard(s) and Client Specific Guideline(s). · ...

The Clinical Denials and Appeals Nurse Specialist (IP & OP) is responsible for reviewing the claims denied and carrying out the appeals process appropriately and in a timely manner.This individual identifies and works denials, responding to the denial reason and resubmitting any ...

The Clinical Denials and Appeals Nurse Specialist (IP & OP) is responsible for reviewing the claims denied and carrying out the appeals process appropriately and in a timely manner.This individual identifies and works denials, responding to the denial reason and resubmitting any ...

+500000* Why join MicroSourcing? · You'll Have Competitive Rewards: Enjoy above-market compensation , healthcare coverage on day one , plus one or more dependents , paid time-off with cash conversion , group life insurance , and performance bonuses A Collaborative Spirit: Contri ...

We are looking for a Clinical Denials & Appeals Nurse Specialist – IP & OP who will review denied inpatient and outpatient claims and manage the appeals process accurately. · Review denied inpatient and outpatient claims. · Evaluate denial reasons using payor information. · ...

We are currently seeking a Clinical Reviewer Specialist to join our team in Manila.Clinical Reviewer Specialists perform clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical necessity for services in accordance ...

The Claims Resolutions Specialist is responsible for preparing and submitting appeals for denied claims, addressing escalated claims, investigating underpayments, and closing accounts when collection efforts have been exhausted. · ...

We are seeking a Clinical Denials Specialist-IP & OP to join our team at MicroSourcing. As a key member of our clinical appeals team, you will play a critical role in ensuring timely denials management.You will work closely with payors to resolve denials and appeals efficiently. ...

Quality assurance specialist required for on-site work in Bridgetowne, Quezon City. · ...

The Claims Specialist manages claim appeals evaluates next steps—whether submitting additional appeals or closing accounts. They prioritize work based on claim complexity maintain accuracy compliance efficiently process high volumes low‑balance claims support timely payments maxi ...