Clinical Denials and Appeals Nurse

AGS Health Philippines, Inc; Taguig; On-site; PHP 357,000 - 580,000; Full time

Job summary

AGS Health Philippines, Inc. is seeking a Clinical Denials and Appeals Nurse to join our team in McKinley, Taguig. This full-time, onsite role requires strong analytic skills to review denied records for medical necessity and coding accuracy.

The ideal candidate holds an RN license, has experience with Medical Policies, CMS LCD/NCD, and denial appeals, and can communicate clearly with MDOs, coding, and charge integrity teams during night shifts.

Qualifications

• RN license is mandatory.
• Strong critical thinking and problem-solving.
• Ability to read and interpret medical policies and coding denials.
• Experience in medical billing, coding, or utilization review preferred.

Responsibilities

• Review denied patient records to determine medical necessity and admission status.
• Validate billing accuracy including UB, PB invoices, EOB, CPT/HCPCS codes.
• Analyze EOBs to identify root causes of claim denials.

Skills

Interpersonal skills

Written communication

Detail-oriented

Independent worker

Organizational skills

Education

RN License

Tools

Microsoft Office

Epic

MIDAS

Billing systems

Job description

Job Title: Clinical Denials and Appeals Nurse

Location: McKinley, Taguig

Shift: Night Shift (M-F)

Work Set-up: Onsite

Core Competencies:

• Strong interpersonal and communication skills.

• Ability to clearly articulate requests verbally and in writing.

• Professional, concise, and detail-oriented communication.

• Ability to work independently and meet deadlines.

• Excellent organizational skills for managing multiple cases.

Communication Expectation:

Interact effectively with:

• MDO (Medical Doctor's Office)

• Coding team

• Charge Integrity team

Written requests must:

• Be specific and professional.

• Include all necessary details upfront.

• Use proper grammar and tone.

Required Qualifications:

• RN License (mandatory).

• Critical thinking and problem-solving skills.

• Excellent attention to detail for accuracy.

• Ability to read and interpret: Medical Policies, CMS LCD/NCD and Coding-related denials.

• Prio experience in: Medical billing, coding, or utilization review (preferred). Writing insurance appeals or handling claim denials (plus).

Technical Skills:

• Proficiency in Microsoft Office (Word, Excel).

• Ability to work in Epic and appeal tracking systems (MIDAS).

• Basic document formatting skills.

Appeals Responsibilities:

• Review denied patient medical records to determine: Appropriate level of care and admission status, Medical necessity.

• Validate billing accuracy: UB, PB invoices, EOB, CPT/HCPCS codes.

• Ability to analyze medical records and Explanation of Benefits (EOB) to accurately identify the root cause of claim denials.

Job Type: Full-time

Work Location: In person