Onsite Night-Shift Clinical Denials & Appeals Nurse

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

Job summary

A healthcare solutions provider in Metro Manila is seeking a PH Registered Nurse to handle medical necessity appeals. The role requires strong English communication skills and a willingness to work night shifts. The ideal candidate should have experience in EOBs and understanding denial causes, ensuring proper account management until resolution. This position offers an onsite opportunity in Taguig.

Qualifications

• Registered Nurse with experience in medical necessity appeals.
• Proficient in reading EOBs and investigating denial root causes.
• Willing to work night shifts.

Responsibilities

• Review medical necessity and authorization denials.
• Utilize payer policies to determine criteria for appeal.
• Write appeal letters using clinical indicators.

Skills

PH Registered Nurse

Reading Explanation of Benefits (EOB)

Navigating various payer and provider portals

Typing speed of at least 45 WPM

Strong command of the English language

Familiarity with MCG and InterQual

Job description

A healthcare solutions provider in Metro Manila is seeking a PH Registered Nurse to handle medical necessity appeals. The role requires strong English communication skills and a willingness to work night shifts. The ideal candidate should have experience in EOBs and understanding denial causes, ensuring proper account management until resolution. This position offers an onsite opportunity in Taguig.