Clinical Appeals Nurse — Lead Medical Denials Resolution

Health Business Solutions LLC; Manila; On-site; PHP 669,600 - 1,004,400; Full time

Benefits offered by this job

Competitive salary and benefits

Opportunities for professional growth

Supportive work environment

Job summary

A healthcare company in the Philippines is seeking a Clinical Appeals Nurse to manage medical denials by providing clinical expertise in the appeals process. This role requires an active RN license and a minimum of two years of bedside experience. The ideal candidate will have experience in clinical appeals and a strong understanding of ICD-10 coding. Competitive salary ranging from 60,000 to 90,000 PhP per month, along with benefits and opportunities for growth.

Qualifications

• Active Registered Nurse (RN) license in the Philippines, US licensed preferred.
• Minimum of two years of bedside clinical experience in a hospital setting.
• At least one year of experience in clinical appeals or utilization management.
• Proficiency with Milliman or Interqual clinical guidelines.
• Strong understanding of ICD-10 coding principles.

Responsibilities

• Review and analyze clinical documentation and insurance denial rationales.
• Engage in the appeals process for denied claims.
• Utilize clinical experience to substantiate medical necessity.
• Collaborate with healthcare providers and insurance companies.
• Maintain accurate records of all appeals processes.

Skills

Analytical thinking

Clinical expertise

Communication skills

Organizational skills

Critical thinking

Education

Registered Nurse (RN) license

Bachelor’s Degree in Nursing (BSN)

Associate Degree in Nursing (ADN)

Job description

A healthcare company in the Philippines is seeking a Clinical Appeals Nurse to manage medical denials by providing clinical expertise in the appeals process. This role requires an active RN license and a minimum of two years of bedside experience. The ideal candidate will have experience in clinical appeals and a strong understanding of ICD-10 coding. Competitive salary ranging from 60,000 to 90,000 PhP per month, along with benefits and opportunities for growth.