Night-Shift Denials & Appeals Specialist - Onsite QC

John Clements Consultants, Inc.; Quezon City; On-site; PHP 350,000 - 600,000; Full time

Job summary

John Clements Consultants, Inc. seeks a qualified Revenue Cycle Specialist to research and resolve payer denials for clinic and surgical services, including preparing corrected claims and written appeals to support timely reimbursement.

This role is onsite at Bridgetowne, Quezon City and requires night shift availability. You will analyze denial reasons, review claim histories and payer adjudication, then coordinate with the Revenue Cycle team to identify root causes and implement appropriate

Qualifications

• Bachelor's degree.
• At least 3 years of experience in healthcare revenue cycle management, denials, appeals, medical billing, insurance follow-up, accounts receivable, or a related role.
• Experience preparing and submitting corrected claims, payer reconsiderations, written appeals, and performing appropriate follow-up through resolution.
• Experience researching claim history, payer adjudication, denial reasons, and supporting account information to determine appropriate resolution.
• Experience utilizing an EMR, and working denials across commercial insurance, Medicare, Medicaid, Medicare Advantage, and other common healthcare payer types.
• Willing to work onsite (Bridgetowne, Quezon City) and night shift schedule.

Responsibilities

• Review, research, and resolve assigned payer denials for clinic and surgical services in accordance with established productivity, quality, and performance standards.
• Analyze denial reasons, claim history, payer adjudication, account documentation, and other available information to identify the root cause of the denial and determine the appropriate action necessary for resolution.
• Take appropriate corrective action on denied claims, including preparing and submitting corrected claims, reconsiderations, written appeals, payer follow-up, and other resolution activities in accordance with payer requirements and established workflows.
• Prepare and submit timely, accurate, and complete written appeals with appropriate supporting documentation and rationale to support reimbursement for services rendered.
• Utilize payer portals, practice management systems, electronic remittance information, payer correspondence, and other available resources to research denial activity, determine claim status, obtain supporting information, submit required documentation, and facilitate resolution.
• Identify denials related to authorization, eligibility, registration, credentialing, payer configuration, or other upstream processes and coordinate with the appropriate Revenue Cycle or operational team to facilitate resolution.

Skills

Healthcare revenue cycle management

Denials & appeals

Medical billing

Insurance follow-up

Accounts receivable

EMR usage

Education

Bachelor's degree

Tools

EMR system

Job description

John Clements Consultants, Inc. seeks a qualified Revenue Cycle Specialist to research and resolve payer denials for clinic and surgical services, including preparing corrected claims and written appeals to support timely reimbursement.

This role is onsite at Bridgetowne, Quezon City and requires night shift availability. You will analyze denial reasons, review claim histories and payer adjudication, then coordinate with the Revenue Cycle team to identify root causes and implement appropriate