Clinical Reviewer Specialty CRS

TASQ Staffing Solutions; Quezon City; On-site; PHP 446,000 - 781,000; Full time

Job summary

TASQ Staffing Solutions seeks a Clinical Reviewer Specialist to maximize healthcare reimbursement by reviewing denied claims, identifying root causes, and developing persuasive appeal strategies. You will analyze medical records, coding data, payer policies, and documentation to determine denial validity and reimbursement opportunities.

This is an onsite role with a focus on quality and impact. The candidate should have active coding certifications, IP DRG / HCC experience, 3+ years in revenue

Qualifications

• Active coding certifications required.
• 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 identify denial reasons, discrepancies, and opportunities for appeal.
• Analyze medical records, coding, payer policies and documentation 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 docs and address recurring denial patterns.

Skills

Coding certifications

PHRN

USRN (plus)

ICD-10-CM/PCS

Denials & Appeals

Medical billing

Revenue cycle

Education

CDAS or equivalent denial management credential

Job description

Job Description:

Target SD: No later than November 1, 2026

Work Setup/Location: ONSITE / BGC, Taguig within 6 months then transfer to Bridgetowne, QC

Work Schedule: Night Shift

The Clinical Reviewer Specialist plays a critical role in maximizing healthcare reimbursement by reviewing denied claims, identifying root causes of denials, and developing clinically and technically sound appeal strategies.

This position reviews medical records, coding and billing documentation, payer policies, and other relevant clinical information to determine the validity of denials and identify opportunities for reimbursement recovery. The Clinical Reviewer Specialist collaborates with healthcare providers and revenue cycle teams to obtain supporting documentation, develop persuasive appeals, and address recurring denial patterns.

The successful candidate will combineclinical expertise, coding and reimbursement knowledge, analytical ability, and strong written and verbal communication skillsto support both revenue recovery and denial prevention initiatives.

This is awork-from-office opportunityfor a clinically credentialed professional seeking to make a measurable impact on financial performance, claim quality, and revenue cycle outcomes.

Duties and Responsibilities:

Denial Review & Appeals

• Demonstrate and consistently apply the Client's Core Values when interacting with team members, clients, providers, payers, and other stakeholders.
• Review denied claims to determine the specific denial reason, identify discrepancies, and assess opportunities for appeal.
• Analyze medical records, clinical documentation, billing records, coding information, and payer correspondence to determine the validity of denials.
• Research and interpret payer medical policies, reimbursement guidelines, contractual requirements, and applicable regulatory requirements.
• Apply knowledge of ICD-10-CM/PCS, CPT, HCPCS, modifiers, and other coding principles to identify coding-related denial issues and validate claim accuracy.
• Evaluate clinical documentation and supporting evidence to determine whether services were appropriately documented and supported.
• Develop clear, concise, and persuasive appeal arguments supported by clinical evidence, coding guidelines, payer policies, and applicable

Communication & Collaboration

• Communicates clearly and persuasively, both verbally and in writing, to collaborate with healthcare providers and present appeal arguments.
• Applies keen attention to detail to ensure accurate review and analysis of denied claims and medical records.
• Performs other duties as assigned.

Non-negotiable Requirements:

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

Preferred:

• Certified Denials and Appeals Specialist (CDAS) or equivalent denial management credential.
• Experience with EHR systems, such as Epic, and payer denial management portals.