Denials & Appeals Specialist - RCM (Night Shift)

Our Clients; Quezon City; On-site; PHP 320,000 - 460,000; Full time

Job summary

Our Clients in Quezon City is seeking a Denials and Appeals Specialist to manage post-service payer denials for clinic and surgical services. The role focuses on researching denials, preparing appeals and corrected claims, coordinating with internal teams, and driving resolution.

The position requires reviewing claim history, payer policies, remittance information, and using payer portals, EMR/practice management systems, to resolve denials and ensure timely filings.

Qualifications

• 3+ years of healthcare RCM experience, focused on denial management.
• Experience researching and resolving payer denials.
• Experience with corrected claims, reconsiderations and appeals.

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.

Skills

Payer denials research

Appeals processing

Payer follow-ups

Tools

EMR systems

Practice management

Payer portals

Job description

Our Clients in Quezon City is seeking a Denials and Appeals Specialist to manage post-service payer denials for clinic and surgical services. The role focuses on researching denials, preparing appeals and corrected claims, coordinating with internal teams, and driving resolution.

The position requires reviewing claim history, payer policies, remittance information, and using payer portals, EMR/practice management systems, to resolve denials and ensure timely filings.