Clinical Appeals Nurse - Champion Medical Necessity

Health Business Solutions LLC; Pasig; On-site; PHP 502,200 - 669,600; Full time

Job summary

A healthcare solutions provider in Metro Manila, Philippines, is looking for a dedicated Clinical Appeals Nurse to manage medical denials and oversee the appeals process. The ideal candidate has experience in clinical practice, analytical thinking, and strong communication skills to articulate complex clinical information effectively. Responsibilities include reviewing clinical documentation, submitting timely appeals, and collaborating with healthcare teams. A nursing degree and relevant experience in clinical appeals are required. This position offers a unique opportunity to impact patient services positively.

Qualifications

• Active Registered Nurse (RN) license in the Philippines; US license preferred.
• Minimum of two years of bedside clinical experience in a hospital setting.
• One year of experience in clinical appeals or utilization management.

Responsibilities

• Review and analyze clinical documentation for appeal cases.
• Engage in the appeals process for denied claims promptly.
• Collaborate with healthcare providers to advocate for patient services.

Skills

Clinical appeals expertise

Analytical thinking

ICD-10 coding proficiency

Communication skills

Organizational skills

Education

Bachelor’s Degree in Nursing (BSN)

Associate Degree in Nursing (ADN)

Job description

A healthcare solutions provider in Metro Manila, Philippines, is looking for a dedicated Clinical Appeals Nurse to manage medical denials and oversee the appeals process. The ideal candidate has experience in clinical practice, analytical thinking, and strong communication skills to articulate complex clinical information effectively. Responsibilities include reviewing clinical documentation, submitting timely appeals, and collaborating with healthcare teams. A nursing degree and relevant experience in clinical appeals are required. This position offers a unique opportunity to impact patient services positively.