Night-Shift RN: Clinical Denials & Appeals (IP & OP)

MicroSourcing; Philippines; On-site; PHP 700,000 - 1,000,000; Full time

Benefits offered by this job

Healthcare coverage on day one

Performance bonuses

Paid time-off with cash conversion

Job summary

MicroSourcing is seeking a Clinical Denials & Appeals Nurse Specialist – IP & OP to join our onsite team in Taguig, night shift. You will review denied claims, craft appeals, and coordinate with payors and internal teams to resolve denials efficiently.

The ideal candidate has 3–5 years acute care experience (ICU preferred), a BSN, active RN license (PHRN/USRN), and strong knowledge of payer policies and clinical guidelines.

Qualifications

• Clinical Appeals experience: at least 1 year.
• Acute care clinical experience: 3–5 years in hospital setting; 2–3 years ICU.
• Bachelor of Science in Nursing.
• Registered Nurse with an active PHRN or USRN license.
• Proficiency with InterQual or MCG guidelines; broad knowledge of U.S. Government Programs.
• Proficiency with EMR systems such as Epic, Cerner, or Meditech.
• Excellent verbal and written English communication (CEFR B2)

Responsibilities

• Work denials and appeals timely, evaluate denial reasons.
• Submit retro-authorizations per payor requirements.
• Conduct medical necessity reviews and prepare documentation for appeals.
• Write and submit timely, well-argued appeals with supporting docs.
• Document actions and follow up with payers.
• Track status and progress of denials and appeals.
• Perform research to stay updated on best practices.
• Communicate clearly with internal/external teams.

Skills

Clinical appeals

Healthcare compliance

Communication skills

Analytical skills

Teamwork

Education

Bachelor of Science in Nursing

RN license (PHRN/USRN)

Tools

Epic EMR

Cerner EMR

Meditech EMR

Job description

MicroSourcing is seeking a Clinical Denials & Appeals Nurse Specialist – IP & OP to join our onsite team in Taguig, night shift. You will review denied claims, craft appeals, and coordinate with payors and internal teams to resolve denials efficiently.

The ideal candidate has 3–5 years acute care experience (ICU preferred), a BSN, active RN license (PHRN/USRN), and strong knowledge of payer policies and clinical guidelines.