Clinical Denials & Appeals Strategist

TASQ; Pateros; On-site; PHP 600,000 - 900,000; Full time

Job summary

TASQ is seeking a Clinical Reviewer Specialist to maximize healthcare reimbursement by reviewing denied claims, identifying root causes of denials, and developing clinically and technically sound appeal strategies.

The role involves reviewing medical records, coding and billing documentation, payer policies, and other clinical information to determine denial validity and opportunities for reimbursement recovery.

Qualifications

• Active coding certifications required.
• Must have active PHRN; USRN is a plus.
• Minimum 3 years in healthcare revenue cycle, medical billing, claims processing, or denial management.
• IP DRG Coding, Inpatient Surgery Coding, Inpatient E&M / Professional Coding, Inpatient HCC / Risk Adjustment Coding.

Responsibilities

• Review denied claims to determine denial reason, identify discrepancies, and assess appeal opportunities.
• Analyze medical records, coding, billing records, and payer correspondence to validate denials.
• Develop clear, persuasive appeal arguments supported by clinical evidence and coding guidelines.
• Collaborate with providers and revenue cycle teams to obtain supporting documentation and address denial patterns.
• Communicate clearly and persuasively, both verbally and in writing, to present appeal arguments.

Skills

Active coding certifications

PHRN

USRN (preferred)

Attention to detail

Communication skills

Tools

Epic EHR

Payer denial portals

Job description

TASQ is seeking a Clinical Reviewer Specialist to maximize healthcare reimbursement by reviewing denied claims, identifying root causes of denials, and developing clinically and technically sound appeal strategies.

The role involves reviewing medical records, coding and billing documentation, payer policies, and other clinical information to determine denial validity and opportunities for reimbursement recovery.