Revenue Cycle Denials Specialist

Health Business Solutions LLC; Cebu City; On-site; PHP 360,000 - 480,000; Full time

Job summary

Health Business Solutions LLC seeks a Revenue Cycle Denials Specialist to identify, investigate, appeal, and resolve denied or underpaid claims to maximize reimbursement and minimize revenue leakage. You will work with payers, coding teams, and clinical staff to ensure timely resolution while complying with payer and regulatory requirements.

Requirements include 2+ years in healthcare revenue cycle, understanding of ICD-10-CM, CPT, HCPCS, and familiarity with EHR/billing systems.

Qualifications

• Minimum 2 years in healthcare revenue cycle management or denial management.
• Understanding of ICD-10-CM, CPT, HCPCS, and medical necessity guidelines.
• Experience with EHR and billing systems.
• Certification such as CPB/CRCR is a plus.

Responsibilities

• Review and analyze denied, rejected, and underpaid claims to determine root causes.
• Research payer policies, contracts, and reimbursement guidelines to support appeals and claim resolution.
• Prioritize denial inventory based on financial impact and timely filing requirements.
• Identify trends and recurring denial patterns and recommend corrective actions.
• Prepare and submit high-quality first-level, second-level, and administrative appeals.
• Draft appeal letters supported by clinical documentation, coding guidelines, and payer policies.
• Follow up with insurance carriers to ensure timely review and adjudication of appealed claims.
• Maximize reimbursement through effective claim correction, reconsideration requests, and appeals.
• Monitor aging denial accounts and ensure timely resolution.
• Track recovered revenue and maintain performance metrics.

Skills

Denials management

Revenue cycle understanding

ICD-10-CM CPT HCPCS knowledge

EHR/billing systems

Excel

Payer portals

Education

CPB/CRCR certification preferred

Tools

EHR systems

Denials software

Job description

Summary

As a Revenue Cycle Denials Specialist you are responsible for identifying, investigating, appealing, and

resolving denied or underpaid healthcare claims to maximize reimbursement and minimize

revenue leakage. The role works closely with payers, providers, coding teams, clinical staff, and

billing departments to ensure timely resolution of denied claims while maintaining compliance with

payer and regulatory requirements.

Key Responsibilities

• Review and analyze denied, rejected, and underpaid claims to determine root causes.
• Research payer policies, contracts, and reimbursement guidelines to support appeals and claim resolution.
• Prioritize denial inventory based on financial impact and timely filing requirements.
• Identify trends and recurring denial patterns and recommend corrective actions.
• Prepare and submit high-quality first-level, second-level, and administrative appeals.
• Draft appeal letters supported by clinical documentation, coding guidelines, and payer policies.
• Follow up with insurance carriers to ensure timely review and adjudication of appealed claims.
• Maximize reimbursement through effective claim correction, reconsideration requests, and appeals.
• Monitor aging denial accounts and ensure timely resolution.
• Track recovered revenue and maintain performance metrics.

Qualifications

• Minimum 2 years of experience in healthcare revenue cycle management, medical billing, collections, or denial management.
• Understanding of ICD-10-CM, CPT, HCPCS, and medical necessity guidelines.
• Experience with electronic health records (EHR) and billing systems.
• Certified Professional Biller (CPB), Certified Revenue Cycle Representative (CRCR), or similar certification is a plus.
• Experience in hospital, physician practice, or healthcare outsourcing/BPO environments is preferred.
• Clinical appeal writing experience preferred.
• Familiarity with payer portals and denial management software.
• Proficiency in Microsoft Excel, Word, and revenue cycle applications.
• Knowledge of healthcare reimbursement methodologies.