Nurse Specialist: Denials & Appeals (IP/OP) — Night Shift

MicroSourcing; Taguig; On-site; PHP 670,000 - 1,004,000; Full time

Benefits offered by this job

Healthcare coverage day one

Dependent coverage

Paid time off with cash conversion

Group life insurance

Performance bonuses

Job summary

MicroSourcing in Taguig seeks a Clinical Denials & Appeals Nurse Specialist (IP & OP) to review denied claims and manage the appeals process across payers. You will communicate with payors via phone, email, and messaging, ensuring timely submissions and accurate documentation.

The role requires 3–5 years acute care experience (ICU preferred), BSN, and active RN licensure. Proficiency in EMR systems like Epic/Cerner/Meditech is essential, with strong English communication and attention to detail.

Qualifications

• At least 1 year of clinical appeals writing experience.
• Minimum 3-5 years acute care clinical experience; ICU 2-3 years preferred.
• Bachelor of Science in Nursing.
• RN license (PHRN or USRN) active.
• Proficiency with EMR systems (Epic/Cerner/Meditech).
• CEFR English level of at least B2, strong written and verbal communication.

Responsibilities

• Manage denials and appeals timely, review denial reasons and policy.
• Submit retro-authorizations where required.
• Prepare clinical documentation summaries for appeals.
• Write and submit appeals with supporting documentation.
• Document actions and follow-up with payers and teams.
• Track status of denials and appeals; stay updated on best practices.

Skills

Clinical appeals writing

Attention to detail

English communication

Independent judgment

Education

Bachelor of Science in Nursing

Tools

Epic

Cerner

Meditech

Microsoft Office

Job description

MicroSourcing in Taguig seeks a Clinical Denials & Appeals Nurse Specialist (IP & OP) to review denied claims and manage the appeals process across payers. You will communicate with payors via phone, email, and messaging, ensuring timely submissions and accurate documentation.

The role requires 3–5 years acute care experience (ICU preferred), BSN, and active RN licensure. Proficiency in EMR systems like Epic/Cerner/Meditech is essential, with strong English communication and attention to detail.