Performs training and provides subject matter expertise on clinical reviews needed to resolve and process appeals to team members. • Reviews medical records and clinical data to determine medical necessity for services in accordance with policies,
Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical necessity for services in accordance with policies, guidelines, and National Committee for Quality Assurance (NCQA) standards. Roles
Work setup: ONSITE / BGC, Taguig within 6 months then transfer to Bridgetowne, QC Work schedule: Nightshift The Team Lead – Clinical Denials provides operational and clinical leadership to a team of Clinical Denials Specialists supporting
Performs training and provides subject matter expertise on clinical reviews needed to resolve and process appeals to team members. • Reviews medical records and clinical data to determine medical necessity for services in accordance