Denials Resolution Specialist — Healthcare Revenue Cycle

Sysgen RPO, Inc.; Pasig; On-site; PHP 260,000 - 420,000; Full time

Job summary

Sysgen RPO, Inc. is seeking a Revenue Cycle Denials Specialist to identify, investigate, appeal, and resolve denied or underpaid healthcare claims, maximizing reimbursement and reducing revenue leakage.

You will collaborate with payers, clinicians, and billing teams to ensure timely resolution while maintaining compliance. The ideal candidate has at least two years in denial management, working with ICD-10-CM, CPT, and HCPCS, plus experience with EHR and billing systems.

Qualifications

• 2+ years in healthcare revenue cycle denial management.
• Knowledge of ICD-10-CM, CPT, HCPCS and medical necessity guidelines.
• Experience with EHR and billing systems.
• CPB/CRCR certification or similar is a plus.
• Experience in hospital/physician practice or healthcare outsourcing/BPO is preferred.
• Technical appeal writing experience preferred.
• Familiarity with payer portals and denial management software.
• Proficiency in Microsoft Excel, Word, and revenue cycle applications.
• Knowledge of healthcare reimbursement methodologies.

Responsibilities

• Review denied, rejected, and underpaid claims to identify root causes.
• Research payer policies and guidelines to support appeals.
• Prioritize denial inventory by financial impact and timely filing.
• Identify trends in denials and suggest corrective actions.
• Prepare and submit first- and second-level appeals.
• Draft appeal letters with clinical documentation and payer policies.
• Follow up with carriers for timely adjudication of appeals.
• Maximize reimbursement through corrections and reconsideration requests.
• Monitor aging denial accounts and track recovery of revenue.
• Maintain performance metrics for denial management.

Skills

Denial management

Claim analysis

Financial optimization

Process improvement

Education

Bachelor’s degree

Tools

EHR systems

Billing systems

Payer portals

Excel

Job description

Sysgen RPO, Inc. is seeking a Revenue Cycle Denials Specialist to identify, investigate, appeal, and resolve denied or underpaid healthcare claims, maximizing reimbursement and reducing revenue leakage.

You will collaborate with payers, clinicians, and billing teams to ensure timely resolution while maintaining compliance. The ideal candidate has at least two years in denial management, working with ICD-10-CM, CPT, and HCPCS, plus experience with EHR and billing systems.