Appeal Writer

Med-Metrix; Pasig; On-site; PHP 223,200 - 334,800; Full time

Benefits offered by this job

8-Hour Shifts, Fixed Weekends Off

Day 1 HMO with dependents covered

Group Life Insurance

Medical Cash Allowance

Paid Time Off

Free Lunch Daily

Employee Engagement Activities

Job summary

Med-Metrix seeks an Appeals Writer to support the review of insurance claims denied for payment on behalf of client hospitals. The role involves collaborating closely with nurses and creating appeal letters in support of claim payments.

Qualifications include being a Registered Nurse with clinical experience in patient care. The position is onsite and requires flexibility to work US hours.

Qualifications

• Must have at least 1 year of strong clinical experience in direct patient care.
• Must possess a high level of reading comprehension.
• US RN not required.

Responsibilities

• Review and analyze appeals and grievances.
• Conduct thorough investigations and gather medical records.
• Prepare detailed case summaries.
• Communicate effectively with members and providers.
• Review denied insurance claims.

Skills

Effective English communication skills

Ability to analyze medical information and terminology

Strong clinical experience in direct patient care

Education

Must be a Registered Nurse

Job description

Experience these exceptional benefits when you join Med-Metrix!

• 8-Hour Shifts, Fixed Weekends Off
• Day 1 HMO with 2 of your dependents covered for FREE
• Group Life Insurance
• Medical Cash Allowance
• Rice Allowance
• Clothing Allowance
• Holiday Gift
• Bereavement Assistance
• Free Lunch Daily
• Paid Time Off
• Training and Staff Development
• Employee Engagement Activities
• Opportunities for Internal Mobility

Appeals Writer

The Appeals Writer supports the Company by reviewing insurance claims denied for payment on behalf of our client hospitals. Working closely with nurses and other team members, the Appeal Writer creates appeal letters in support of claim payment.

Duties And Responsibilities

• Review and analyze appeals and grievances to determine appropriate resolutions
• Ensure compliance with CMS (Centers for Medicare & Medicaid Services) regulations and guidelines, and client specific rules
• Conduct thorough investigations, including gathering and reviewing medical records, provider documentation, and member information
• Prepare detailed case summaries and decision letters
• Communicate effectively with members, providers, and regulatory agencies to resolve issues
• Maintain accurate and up-to-date records of all appeals and grievances
• Identify trends and provide recommendations for process improvements
• Collaborate with internal departments to ensure timely and accurate resolution of casesAbility to work in a fast paced and production environment
• Review denied insurance claims
• Review patients’ medical files
• Develop strategies to reverse claim denials
• Create written appeals
• Manage and organize appeal workflow based on internal, client-based, and insurance-driven deadlines
• Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards

Qualifications

• Must be a Registered Nurse. US RN, not required
• Must have at least 1 year of strong clinical experience in direct patient care within acute setting such as ICU, ER, Med-Surg, or general acute care units
• Must have effective English communication skills in both written and verbal
• Must possess a high level of reading comprehension and ability to analyze medical information and terminology

Working Conditions

• Work Set-up: Onsite
• Work Schedule: US hours, night shift; must be flexible to accommodate business needs.
• Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.
• Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.
• Work Environment: The noise level in the work environment is usually minimal.

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.