Appeals Writer & Denial Resolution Analyst

Talkpush; Taguig; On-site; PHP 420,000 - 540,000; Full time

Job summary

Talkpush is seeking a qualified professional to validate dispute reasons after EOB review and to escalate payment variance trends to NIC management. The role includes generating appeals for denied or underpaid claims and coordinating with clinical and billing teams to ensure accurate coding.

The candidate will follow payer guidelines for submissions, research contract terms, and prepare documentation for IMaCS adjudication issues while ensuring proper routing of accounts for resolution.

Qualifications

• Intermediate understanding of Explanation of Benefits form (EOB) and Managed Care.
• Contracts, Contract Language and Federal and State Requirements.
• Intermediate knowledge of hospital billing form requirements (UB-04).
• ICD-9, HCPCS/CPT coding, and medical terminology knowledge.
• Microsoft Office (Word, Excel) skills.
• Advanced business letter writing with correct grammar and punctuation.

Responsibilities

• Validate denial reasons and ensure coding in DCM is accurate; coordinate with CRC for consultations or referrals.
• Generate an appeal based on dispute reasons and contract terms; include online reconsiderations.
• Follow payer guidelines for appeals submissions.
• Escalate exhausted appeal efforts for resolution.
• Research contract terms and prepare supporting documentation for appeals and IMaCS adjudication issues.
• Code the DCM system appropriately and route accounts, based on research and corrective actions.
• Escalate denial or payment variance trends to NIC leadership.

Skills

EOB/Managed Care knowledge

Contracts & language comprehension

UB-04 coding

ICD-9/HCPCS/CPT coding

Microsoft Word

Microsoft Excel

Professional writing/grammar

Tools

Microsoft Word

Microsoft Excel

Job description

Talkpush is seeking a qualified professional to validate dispute reasons after EOB review and to escalate payment variance trends to NIC management. The role includes generating appeals for denied or underpaid claims and coordinating with clinical and billing teams to ensure accurate coding.

The candidate will follow payer guidelines for submissions, research contract terms, and prepare documentation for IMaCS adjudication issues while ensuring proper routing of accounts for resolution.