Denials & Appeals Specialist - Night Shift

John Clements Consultants, Inc.; Quezon City; On-site; PHP 279,000 - 469,000; Full time

Job summary

John Clements Consultants, Inc. is seeking a Denials and Appeals Specialist to manage insurance follow-ups, review denials, and prepare appeals to ensure timely reimbursement. The role requires at least 2 years in medical billing and willingness to work onsite in Bridgetowne, Quezon City, including night shifts.

You will handle AR days reduction, correspondence, and stay updated on policy changes while maintaining confidentiality and quality standards.

Qualifications

• Bachelor's degree or undergraduate.
• At least 2 years of experience in medical billing, insurance follow-up, claims processing, appeals and denials or collections.
• Strong understanding of the healthcare insurance industry, managed care policies, reimbursement processes, and medical office operations.
• Experience with eClinicalWorks (eCW), EPIC, AthenaOne, or Waystar is an advantage but not required.
• Excellent communication and customer service skills, with the ability to build effective working relationships with patients, colleagues, and insurance representatives.
• Willing to work onsite (Bridgetowne, Quezon City) and night shift schedule.

Responsibilities

• Manage insurance follow-ups and collections for assigned insurance payors.
• Review denied claims and identify the reasons for denial, including billing and coding discrepancies.
• Prepare and submit appeals or coordinate with the coding team for further review and correction, as necessary.
• Follow up on outstanding and unpaid claims to minimize accounts receivable (AR) days and improve collections.
• Process and manage incoming insurance correspondence and mail.
• Monitor insurance payor policies, network bulletins, and reimbursement updates that may affect the practice.
• Coordinate with insurance representatives to resolve claim-related concerns and payment issues.
• Maintain compliance with company policies, safety procedures, confidentiality requirements, and quality standards.

Skills

Communication skills

Customer service

Relationship building

Education

Bachelor's degree or undergraduate

Tools

eClinicalWorks (eCW)

EPIC

AthenaOne

Waystar

Job description

John Clements Consultants, Inc. is seeking a Denials and Appeals Specialist to manage insurance follow-ups, review denials, and prepare appeals to ensure timely reimbursement. The role requires at least 2 years in medical billing and willingness to work onsite in Bridgetowne, Quezon City, including night shifts.

You will handle AR days reduction, correspondence, and stay updated on policy changes while maintaining confidentiality and quality standards.