USRN Clinical Reviewer
AscenTPro
- Taguig, PhilippinesAnnapolis, Taguig, Metro Manila, PhilippinesTaguigMetro ManilaPhilippinesPhilippines
- ₱40,000.00 - ₱50,000.00 / monthPHP400005000040000MONTH
- Full timeFULL_TIME
Expired 4 years ago
2019-11-14T16:00:00+00:00Job closed.
Job Description
- Act as a Subject Matter Expert for other team members
- Manage the intake of members or the admission/discharge information post notification
- Work with hospitals, clinics, facilities, and the clinical team to manage request for services from members and/or providers
- Manage the referrals process, processing incoming and outgoing referrals and prior authorizations, including intake, notification and census roles
- Provide appropriate triage and care coordination notification cases for non-clinical assessment/intervention
- Process notification requirements
- Assist the clinical staff with setting up documents/triage cases for Clinical Coverage Review
Handle resolution/inquiries from members and/or providers that may include:
- Benefit and Eligibility information
- Billing and Payment issues
- Customer material requests
- Physician assignments
- Authorization for treatment
- Explanation of Benefits (EOB)
Minimum Qualifications
Required Qualifications:
- Graduate of BS Nursing
- Must be a Registered Nurse with an active license
- Must have a USRN License on a Mainland State (not NMI/Saipan, Guam etc.)
- At least 2 years of Hospital experience from the following areas: Critical Care, Medical Surgical, Hemodialysis experience
- Experience working within the Healthcare Industry
- Working knowledge of Medical Terminology to communicate with members and providers
- Ability to create, edit, save and send documents utilizing Microsoft Word and Excel
- Ability to navigate a PC to open applications, send emails and conduct data entry
Preferred Qualifications:
- Professional experience in a clerical or administrative support related role
- Experience working with Healthcare Insurance
- Experience working in a Hospital, Physician's Office or Medical Clinical setting
- Experience working with ICD-9 and CPT codes
- Experience working with Medicare and/or Medicaid Services
Jobs Summary
- Job Level
- Associate / Supervisor
- Job Category
- Health and Medical
- Educational Requirement
- Bachelor's degree graduate
- Recruiter response to application
- Sometimes
- Office Address
- Annapolis
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About AscenTPro
AscenTPRO (Professional Recruitment Outsourcing) is AscenT’s managed Recruitment & Talent Search arm.
It is focused on providing highly competent, dynamic, and forward-thinking staff in the following Industries: BPOs, Banking, Finance and Insurance Services, Manufacturing and Retail, IT, as well as Healthcare companies. AscenTPRO endeavors to power clients in these fields with a steady and strong pool of qualified front-line, management, and senior executive employees.
AscenTPRO takes Oursourced Recruitment a notch higher by providing consummate expertise in all interactions. Program Leaders in AscenTPRO are dedicated to each vertical, ensuring grassroots knowledge in areas such as Banking, Finance & Accounting, Healthcare, and BPO. This subject-matter expertise is implemented in order to bring goals into reality, as well as facilitate Quality hiring throughput.
Our President & CEO, as well as our Senior Advisor are the same Executives that established IPAMS Philippine Division, a 40-year old company under IPAMS® that specializes in Local and International placement that serves hundreds of multinational companies in the US, Asia, Middle East, and Europe.
Part of our Team’s workflow includes a detailed immersion in your Operations, Methodologies, and Processes in order to ascertain that the solutions we deliver are expertly crafted and tailored to your needs. Our recruitment programs not only focus on meeting numbers and headcount; we also ensure high quality interactions and quick turnaround that translate to better efficiency and faster return of your investment.
We partner with various Institutions, the Academe, and Local Government Units to maintain a steady stream of ready and qualified candidates who will suit your needs. The Company believes that giving back to the Filipino People, through providing Jobs, is our way of creating a niche in the market.