Remote Clinical Appeals Specialist – InterQual Expert

Concentrix Philippines; Quezon City; Remote; PHP 480,000 - 720,000; Full time

Job summary

Concentrix Philippines is seeking a Clinical Appeals Specialist (PHRN) to review, process, and resolve appeals in line with NCQA and CMS standards. You will ensure timely, clinically sound determinations and support case documentation for payor programs.

The role requires a BS Nursing with an active PHRN license, 1 year with InterQual or MCG, and 2 years bedside ICU/CCU/ER experience. Remote work setup is required.

Qualifications

• BS Nursing degree and active PHRN license.
• Minimum 1 year experience with InterQual or MCG.
• Minimum 2 years bedside experience in ICU/CCU/ER.
• Must have stable internet and home office setup for WFH.

Responsibilities

• Apply InterQual or MCG to determine medical necessity of services.
• Coordinate with healthcare providers to ensure clinical documentation supports care level.
• Maintain high accuracy and productivity in a remote, fast-paced environment.

Skills

InterQual

MCG

Remote work readiness

Education

BS Nursing

PHRN License

Job description

Concentrix Philippines is seeking a Clinical Appeals Specialist (PHRN) to review, process, and resolve appeals in line with NCQA and CMS standards. You will ensure timely, clinically sound determinations and support case documentation for payor programs.

The role requires a BS Nursing with an active PHRN license, 1 year with InterQual or MCG, and 2 years bedside ICU/CCU/ER experience. Remote work setup is required.