Night-Shift Clinical Denials & Appeals Specialist

weSource Management Consultancy Firm; Taguig; On-site; PHP 761,670 - 912,330; Full time

Job summary

weSource Management Consultancy Firm is hiring a Clinical Denials & Appeals Specialist for onsite work in BGC Taguig. This role requires 1 year of appeals writing and 3 years of clinical experience, alongside an active PHRN or USRN license. The specialist will manage denials and appeals, conduct medical reviews, and submit necessary documentation, ensuring compliance with regulations. The compensation can go up to ₱75,000 based on experience.

Qualifications

• 1 year of Appeals Writing experience required.
• 3-5 years of acute care experience and 2-3 years in ICU are necessary.
• Active PHRN or USRN licensure required.

Responsibilities

• Manage denials and appeals, ensuring accurate processing.
• Submit retro-authorizations for denial cases.
• Conduct medical necessity reviews and document appeals.

Skills

Appeals Writing

Clinical experience

English proficiency (CEFR B2+)

InterQual/MCG knowledge

EMR systems (Epic, Cerner, Meditech)

Education

BS Nursing

Job description

weSource Management Consultancy Firm is hiring a Clinical Denials & Appeals Specialist for onsite work in BGC Taguig. This role requires 1 year of appeals writing and 3 years of clinical experience, alongside an active PHRN or USRN license. The specialist will manage denials and appeals, conduct medical reviews, and submit necessary documentation, ensuring compliance with regulations. The compensation can go up to ₱75,000 based on experience.