Night-Shift Nurse: Medical Denials & Appeals Expert

Recruitify_HR; Taguig; On-site; PHP 360,000 - 600,000; Full time

Job summary

A healthcare staffing agency is seeking a PH Registered Nurse with experience in medical necessity appeals for an onsite night shift role in Taguig. The candidate will review denials, write appeal letters, and manage accounts until resolution. Must possess strong English skills and the ability to navigate various payer portals. This role requires night shifts for communication with payers and does not permit USRN licenses.

Qualifications

• Must have at least 6 months of experience in medical necessity and lack of authorization appeals.
• Must be familiar with MCG and InterQual criteria.
• Must NOT hold a USRN license.

Responsibilities

• Review inpatient and outpatient medical necessity and authorization denials.
• Utilize payer policies and criteria to determine appeal eligibility.
• Write appeal letters citing appropriate documentation.
• Manage accounts until payment is received or written-off.
• Provide quality reporting and educational support.

Skills

Medical necessity appeals

Authorization appeals

Strong command of English

Typing speed of at least 45 WPM

Navigating payer and provider portals

Education

PH Registered Nurse

Job description

A healthcare staffing agency is seeking a PH Registered Nurse with experience in medical necessity appeals for an onsite night shift role in Taguig. The candidate will review denials, write appeal letters, and manage accounts until resolution. Must possess strong English skills and the ability to navigate various payer portals. This role requires night shifts for communication with payers and does not permit USRN licenses.