Healthcare Denials Optimization Specialist

SYSGEN RPO; Pasig; On-site; PHP 420,000 - 720,000; Full time

Job summary

SYSGEN RPO is seeking a Revenue Cycle Denials Specialist to identify and resolve denied or underpaid healthcare claims, maximizing reimbursement while ensuring compliance. You will collaborate with payers, providers, coding and billing teams to resolve denials efficiently.

The role requires at least a college degree and 2 years in denial management, with knowledge of ICD-10-CM, CPT/HCPCS, and EHR systems. Certifications such as CPB/CRCR are a plus.

Qualifications

• College graduate or equivalent (Bachelor’s degree preferred).
• Minimum 2 years of experience in healthcare revenue cycle management specifically denial management.
• Understanding of ICD-10-CM, CPT, HCPCS, and medical necessity guidelines.
• Experience with electronic health records (EHR) and billing systems.
• Certified Professional Biller (CPB), Certified Revenue Cycle Representative (CRCR), or similar certification is a plus.
• Experience in hospital, physician practice, or healthcare outsourcing/BPO environments 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 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.

Skills

ICD-10-CM knowledge

CPT/HCPCS knowledge

Medical necessity guidelines

EHR and billing systems

Excel/Word proficiency

Appeal writing

Payer portals

Education

Bachelor’s degree or equivalent

Tools

Billing systems

Job description

SYSGEN RPO is seeking a Revenue Cycle Denials Specialist to identify and resolve denied or underpaid healthcare claims, maximizing reimbursement while ensuring compliance. You will collaborate with payers, providers, coding and billing teams to resolve denials efficiently.

The role requires at least a college degree and 2 years in denial management, with knowledge of ICD-10-CM, CPT/HCPCS, and EHR systems. Certifications such as CPB/CRCR are a plus.