Denials & Appeals Specialist - Medical Billing

SYSGEN RPO; Pasig; On-site; PHP 300,000 - 480,000; Full time

Job summary

Sysgen RPO is seeking a Medical Billing Specialist for direct hire to join our Ortigas, Pasig City team. The role focuses on denial management, claims review, and revenue cycle optimization in a healthcare setting.

The ideal candidate has a clinical background, at least 2 years in denial management, knowledge of ICD-10-CM, CPT, and payer policies, and proficiency with EHR/billing systems. CPB/CRCR cert is a plus.

Qualifications

• Bachelor’s degree or equivalent; clinical background preferred.
• Minimum 2 years in healthcare revenue cycle management focusing on denial management.
• Familiarity with ICD-10-CM, CPT, HCPCS, and medical necessity guidelines.

Responsibilities

• Review and analyze denied, rejected, and underpaid claims to determine root causes.
• Research payer policies, contracts, and reimbursement guidelines to support appeals and claim resolution.
• Prioritize denial inventory based on financial impact and timely filing requirements.
• Identify trends and recurring denial patterns and recommend corrective actions.
• Prepare and submit high-quality first-level, second-level, and administrative appeals.
• Draft appeal letters supported by clinical documentation, coding guidelines, and payer policies.
• Follow up with insurance carriers to ensure timely review and adjudication of appealed claims.
• Maximize reimbursement through effective claim correction, reconsideration requests, and appeals.
• Monitor aging denial accounts and ensure timely resolution.
• Track recovered revenue and maintain performance metrics.

Job description

Sysgen RPO is seeking a Medical Billing Specialist for direct hire to join our Ortigas, Pasig City team. The role focuses on denial management, claims review, and revenue cycle optimization in a healthcare setting.

The ideal candidate has a clinical background, at least 2 years in denial management, knowledge of ICD-10-CM, CPT, and payer policies, and proficiency with EHR/billing systems. CPB/CRCR cert is a plus.