Clinical Denials & Appeals Nurse Specialist (IP & OP)

TalentBuzz Recruitment Agency; Taguig; On-site; PHP 502,200 - 725,400; Full time

Benefits offered by this job

Commission

Performance Bonus

Life Insurance

HMO

Maternity & Paternity Leave

Sick Leave

Vacation Leave

Job summary

TalentBuzz Recruitment Agency is seeking a Clinical Denials & Appeals Nurse Specialist in Taguig. The role requires a Bachelor's degree in Nursing and 3-5 years of clinical nursing experience. Responsibilities include reviewing clinical denial cases, preparing appeals, and collaborating with medical staff on billing issues. Strong analytical and communication skills are essential. The position offers on-site work and various employee benefits including bonuses and health insurance.

Qualifications

• 3-5 years of experience in clinical nursing or related field.
• Strong analytical and communication skills.
• Ability to work independently and in a team.

Responsibilities

• Review and analyze clinical denial cases.
• Prepare and submit appeals for denied claims.
• Collaborate with medical staff on billing issues.
• Stay updated on clinical guidelines and payer policies.
• Provide training on denial prevention strategies.

Skills

Strong analytical skills

Excellent communication skills

Attention to detail

Ability to work independently

Knowledge of healthcare billing and coding

Education

Bachelor's degree in Nursing

Job description

Clinical Denials & Appeals Nurse Specialist (IP & OP)

TalentBuzz Recruitment Agency

On-site - Taguig 3-5 Yrs Exp Bachelor Full-time

Job Description

Employee Recognition and Rewards

• Commission
• Performance Bonus

Insurance Health & Wellness

• Life Insurance
• HMO

Professional Development

• Maternity & Paternity Leave
• Sick Leave
• Vacation Leave

• Review and analyze clinical denial cases related to inpatient and outpatient services.
• Prepare and submit comprehensive appeals for denied claims to insurance providers.
• Collaborate with medical staff to gather necessary documentation and resolve billing issues.
• Stay updated on clinical guidelines and payer policies to effectively manage appeals.
• Provide education and training to nursing staff on denial prevention strategies.

Requirements

• Educational Qualifications: Bachelor’s degree in Nursing or a related field
• Experience Level: 3-5 years of experience in clinical nursing or related field
• Skills and Competencies: Strong analytical skills and attention to detail
• Skills and Competencies: Excellent communication and interpersonal skills
• Qualities and Traits: Ability to work independently and collaboratively in a team environment
• Responsibilities and Duties: Knowledge of healthcare billing and coding processes