PHRN - Grievance & Appeals Specialist (Hybrid)

Philippines·TaguigFull-timemid

OtherAppeals Specialist

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Quick Summary

Key Responsibilities

Clinical Review & Documentation: Analyzing medical records for accuracy, compliance, and appropriateness of care. Claims Processing: Determining patient eligibility, validating medical claims,

Technical Tools

OtherAppeals Specialist

Requirements

~1 min read

PHRN with Active license
Must have at least 1 year grievance & case appeals experience
Back-office (Non-voice)

Responsibilities

~1 min read

→Clinical Review & Documentation: Analyzing medical records for accuracy, compliance, and appropriateness of care.
→Claims Processing: Determining patient eligibility, validating medical claims, and managing insurance coverage.
→Utilization Management: Reviewing treatment plans against medical policies to ensure cost-effective care.
→Case Management & Liaison: Communicating with healthcare providers and patients to facilitate care and resolve inquiries.