Staff nurse - Taguig

Job Description

USRN Trainer | Denials and Appeals | WFH after training

We currently looking for a USRN Trainer to be part of our PIONEER USRN TEAM!

In this role, you will be responsible for developing and delivering comprehensive training programs for staff involved in the denials and appeals process. The ideal candidate will have a strong clinical background, expertise in appeals management, and a passion for teaching and improving the skill set of others within the healthcare revenue cycle.

Key Responsibilities:

Training & Development:

• Develop, update, and deliver training programs to staff responsible for handling denials and appeals.
• Create training materials such as manuals, presentations, and online modules to ensure consistent knowledge transfer.
• Conduct hands-on workshops, group sessions, and one-on-one training to address team-specific learning needs.

Process Improvement:

• Collaborate with department leadership to identify knowledge gaps and create targeted training interventions.
• Stay up-to-date on payer guidelines, healthcare regulations, and industry best practices to ensure training is aligned with current standards.
• Analyze appeal trends and issues to create tailored learning sessions aimed at reducing denials and improving appeal success rates.

Quality Assurance:

• Ensure that staff are proficient in medical coding, documentation standards, and payer-specific requirements for appeals.
• Conduct post-training assessments and ongoing performance evaluations to ensure knowledge retention and application in real-world scenarios.
• Monitor staff performance and provide follow-up training as needed to ensure ongoing improvement in denial resolution and compliance.

Collaboration & Support:

• Work closely with clinical and administrative leaders to ensure training aligns with organizational goals and compliance standards.
• Support the appeals team in addressing complex cases or specific issues through additional training and guidance.
• Foster a collaborative environment by encouraging feedback and continuous learning.

Qualifications/Requirements

Qualifications:

• Active USRN license
• At least 1 year of hospital experience.
• At least 1 year experience as Trainer in healthcare BPO set up
• Experience in Utilization Review, Denials Management, or Appeals Writing
• Must have experience/knowledge in Oncology
• Strong understanding of medical necessity, clinical guidelines ( InterQual, MCG, NCD, LCD ) and payer requirements.
• Excellent written communication and critical thinking skills.
• Experience working with EMRs, UM software, and payer portals.

Work location

TAGUIG CITY, NCR, FOURTH DISTRICT

Remarks

Apply now