Denials and Appeals Specialist

PM Consulting; Quezon City; Presencial; PHP 391.000 - 614.000; Jornada completa

Descripción de la vacante

PM Consulting is seeking a Denials and Appeals Specialist to handle post-service payer denials for clinic and surgical services in Onsite Bridgetowne, Quezon City. You will research denials, prepare appeals, and coordinate with internal teams to drive resolution.

The role requires 3+ years in healthcare RCM, hands-on denial resolution experience, and familiarity with EMR and practice management systems. Night shift, onsite setting, in Corporate – Revenue Cycle Management.

Formación

• 3+ years of healthcare RCM experience, preferably in denial management, medical billing, insurance follow-up, or AR.
• Hands-on experience researching and resolving payer denials.
• Experience with corrected claims, reconsiderations, appeals, and payer follow-ups.
• Familiarity with EMR, practice management, and payer portals.

Responsabilidades

• Review and research payer denials and determine the appropriate resolution.
• Prepare and submit corrected claims, reconsiderations, and written appeals with supporting documentation.
• Conduct payer follow-ups and monitor accounts through final resolution.
• Review claim history, payer policies, remittance information, and account documentation.
• Use payer portals, EMR/practice management systems, and other RCM tools to research and resolve denials.
• Coordinate with Coding and other Revenue Cycle teams for coding, authorization, eligibility, documentation, and other denial issues.
• Maintain accurate documentation and ensure timely action based on payer filing and appeal deadlines.
• Identify recurring denial trends and assist in denial prevention and process improvement.

Conocimientos

RCM experience

Payer denials research

Claims corrections

Payer follow-ups

Herramientas

EMR

Practice Management System

Payer Portals

Descripción del empleo

Denials and Appeals Specialist

Work Location: Bridgetowne, Quezon City
Work Setup: Onsite
Shift: Night Shift
Department: Corporate – Revenue Cycle Management

Job Description

We are looking for a Denials and Appeals Specialist to handle post-service healthcare payer denials for clinic and surgical services. The role focuses on researching denials, preparing appeals and corrected claims, coordinating with internal teams, and following through until resolution.

Key Responsibilities

• Review and research payer denials and determine the appropriate resolution.
• Prepare and submit corrected claims, reconsiderations, and written appeals with supporting documentation.
• Conduct payer follow-ups and monitor accounts through final resolution.
• Review claim history, payer policies, remittance information, and account documentation.
• Use payer portals, EMR/practice management systems, and other RCM tools to research and resolve denials.
• Coordinate with Coding and other Revenue Cycle teams for coding, authorization, eligibility, documentation, and other denial issues.
• Maintain accurate documentation and ensure timely action based on payer filing and appeal deadlines.
• Identify recurring denial trends and assist in denial prevention and process improvement.

Qualifications

• 3+ years of healthcare RCM experience, preferably in denial management, medical billing, insurance follow-up, or AR.
• Hands-on experience researching and resolving payer denials.
• Experience with corrected claims, reconsiderations, appeals, and payer follow-ups.
• Familiarity with EMR, practice management, pat