Job Description
Overview
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 SOPs including documentation in the EMR, including appeal package creation
- Manage the accounts un...