Clinical Denials & Appeals Specialist — Coding Certification

Outsourcey; Taguig; On-site; PHP 3,769,000 - 5,653,000; Full time

Job summary

Outsourcey seeks a Clinical Reviewer Specialist to review denied claims, analyze medical records and payer policies, and develop persuasive appeals. The role integrates clinical knowledge with coding and reimbursement guidelines to maximize reimbursement and reduce denials.

The candidate will collaborate with providers and revenue cycle teams, gather supporting documentation, and craft compelling appeals while maintaining high attention to detail. Travel to client sites may be required.

Qualifications

• Relevant degree in health information management or related field.
• Active coding certification preferred.
• Minimum 3 years in healthcare revenue cycle, billing, or denials.

Responsibilities

• Review denied claims to determine denial reason and opportunities for appeal.
• Analyze medical records, coding, and payer communications for validity.
• Develop persuasive appeal arguments with clinical evidence and guidelines.
• Collaborate with providers and revenue cycle teams to obtain documentation.
• Maintain attention to detail in reviewing denials and documentation.
• Travel to client sites as needed.

Skills

Healthcare revenue cycle

Medical billing

Denial management

Coding knowledge

Clinical documentation review

Appeal writing

Regulatory compliance

Travel willingness

Education

Health Information Management

Coding certification

Tools

Epic EHR

Payer portals

Job description

Outsourcey seeks a Clinical Reviewer Specialist to review denied claims, analyze medical records and payer policies, and develop persuasive appeals. The role integrates clinical knowledge with coding and reimbursement guidelines to maximize reimbursement and reduce denials.

The candidate will collaborate with providers and revenue cycle teams, gather supporting documentation, and craft compelling appeals while maintaining high attention to detail. Travel to client sites may be required.