Revenue Cycle Denials Specialist

SALES RAIN BPO, INC.; Manila; On-site; PHP 391,000 - 614,000; Full time

Job summary

SALES RAIN BPO, INC. seeks a Revenue Cycle Denials Specialist to identify, investigate, appeal, and resolve denied or underpaid healthcare claims. You will work with payers, providers, coding teams, clinical staff, and billing teams to maximize reimbursement while staying compliant with payer rules.

The role requires 2+ years in revenue cycle, familiarity with ICD-10-CM/CPT/HCPCS, and knowledge of denial management tools. CPB/CRCR certification is preferred; EHR systems experience is essential.

Qualifications

• College graduate or equivalent (Bachelor’s degree preferred).
• 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 preferred.
• 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.

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

Denial management

Healthcare billing

CPB/CRCR knowledge

Excel

Payer communication

Education

Bachelor’s degree

Tools

EHR systems

Denial management software

Payer portals

Job description

Summary: The Revenue Cycle Denials Specialist is responsible for identifying, investigating, appealing, and resolving denied or underpaid healthcare claims to maximize reimbursement and minimize revenue leakage. This 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

• College graduate or equivalent (Bachelor’s degree preferred)
• 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 preferred.
• 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