Clinical Analyst (US Registered Nurse (RN) or Licensed Vocational Nurse license)

Updated: May 11, 2024 05:59 AM GMT

DOXA Talent

Taguig, Metro Manila

ROLE SUMMARY

Our client is looking for a Clinical Analyst who will be responsible for the review and assessment of clinical denials, including review of patient medical information, patient account documents, patient account history, historical data, provider contracts, and regulations as appropriate. The Clinical Analyst will support and ensure the performance, productivity, efficiency, and profitability of the organization through accurately reviewing, validating, and where appropriate liquidating inventory.

The Clinical Analyst will draft focused, successful appeals, meet, and confer documents, and IRO submissions, and when necessary, assist with legal submissions on clinical issues and communicate with hospital case management personnel to confirm facts, solicit needed information, and assist in managing the clinical review program. The Clinical Analyst will provide support to legal staff on patient accounts and presentation of matters needed and assist with building the... More Detail