Night Shift RN: Denials & Appeals Specialist

AGS Health Philippines, Inc; Taguig; On-site; PHP 357,000 - 580,000; Full time

Job summary

AGS Health Philippines, Inc. is seeking a Clinical Denials and Appeals Nurse to join our team in McKinley, Taguig. This full-time, onsite role requires strong analytic skills to review denied records for medical necessity and coding accuracy.

The ideal candidate holds an RN license, has experience with Medical Policies, CMS LCD/NCD, and denial appeals, and can communicate clearly with MDOs, coding, and charge integrity teams during night shifts.

Qualifications

• RN license is mandatory.
• Strong critical thinking and problem-solving.
• Ability to read and interpret medical policies and coding denials.
• Experience in medical billing, coding, or utilization review preferred.

Responsibilities

• Review denied patient records to determine medical necessity and admission status.
• Validate billing accuracy including UB, PB invoices, EOB, CPT/HCPCS codes.
• Analyze EOBs to identify root causes of claim denials.

Skills

Interpersonal skills

Written communication

Detail-oriented

Independent worker

Organizational skills

Education

RN License

Tools

Microsoft Office

Epic

MIDAS

Billing systems

Job description

AGS Health Philippines, Inc. is seeking a Clinical Denials and Appeals Nurse to join our team in McKinley, Taguig. This full-time, onsite role requires strong analytic skills to review denied records for medical necessity and coding accuracy.

The ideal candidate holds an RN license, has experience with Medical Policies, CMS LCD/NCD, and denial appeals, and can communicate clearly with MDOs, coding, and charge integrity teams during night shifts.