Job Title

Clinical Denials & Appeals Nurse Specialist – IP & OP

Location

Taguig, Metro Manila, Philippines

Employment Type & Setting

Full-Time, On-Site, Night shift

Sign-On Bonus

₱50,000

Job Summary

The Clinical Denials and Appeals Nurse Specialist (IP & OP) reviews denied claims and conducts the appeals process promptly and accurately. The role requires knowledge of U.S. state and federal laws related to payer contracts and the appeals process, as well as strong communication, analytical, and independent work skills.

Responsibilities

• Work denials and appeals in a timely manner, evaluating denial reasons and reviewing clinical documentation.
• Submit retro-authorizations in accordance with payer requirements.
• Conduct medical necessity reviews and prepare clinical documentation summaries for appeals.
• Write and submit compelling written appeals that ...