Appeals Writer PHRN (Non - Voice)

MED-METRIX INTERNATIONAL PH-I, INC.; Eastern Manila District; On-site; PHP 335,000 - 502,000; Full time

Benefits offered by this job

8-Hour Shifts

Fixed Weekends Off

Day 1 HMO with 2 dependents covered

Group Life Insurance

Medical Cash Allowance

Rice Allowance

Clothing Allowance

Holiday Gift

Bereavement Assistance

Free Lunch Daily (onsite)

Paid Time Off

Training and Staff Development

Employee Engagement Activities

Internal Mobility Opportunities

Job summary

Med-Metrix International PH-I, Inc. is seeking an Appeals Writer in the Manila area. The role involves reviewing denied claims, working with nurses and team members, and drafting appeal letters to support claim payments.

The position requires an RN with at least 1 year of direct patient care experience and strong English communication skills. Onsite work with comprehensive benefits is provided.

Qualifications

• Must be a Registered Nurse.
• At least 1 year of strong clinical experience in direct patient care in acute settings (ICU/ER/Med-Surg or similar).
• Must have effective English communication in written and verbal form.

Responsibilities

• Review and analyze appeals and grievances to determine resolutions.
• Ensure compliance with CMS regulations and client rules.
• Conduct investigations by gathering medical records, provider docs, and member info.
• Prepare detailed case summaries and decision letters.
• Communicate with members, providers, and regulatory agencies to resolve issues.
• Maintain accurate records of all appeals and grievances.
• Identify trends and suggest process improvements.
• Collaborate with internal departments to ensure timely resolutions.

Skills

English communication

HIPAA compliance

Medical terminology

Analytical reading

Education

Registered Nurse (RN)

Job description

Experience these Xtraordinary 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 (for onsite employees)

• Paid Time Off

• Training and Staff Development

• Employee Engagement Activities

• Opportunities for Internal Mobility

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 cases

• Ability 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

• 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.