Revenue Cycle Denials Specialist

Health Business Solutions; Pasig; Sur place; PHP 350 000 - 520 000; Plein temps

Résumé du poste

Health Business Solutions is seeking a Revenue Cycle Denials Specialist in the Philippines. You will analyze denied or underpaid claims, research payer policies, and draft appeals to maximize reimbursement while ensuring compliance with regulations.

You will work with EHR and billing systems, common denial patterns, and use payer portals to track resolutions. A Bachelor’s degree and 2+ years in denial management are preferred.

Qualifications

• 2+ years of experience in healthcare revenue cycle management, specifically denial management.
• Familiarity with ICD-10-CM, CPT, HCPCS and medical necessity guidelines.
• Experience with EHR and billing systems.
• CPB, CRCR or similar certification is a plus.

Responsabilités

• Review denied, rejected, and underpaid claims to determine root causes.
• Research payer policies and guidelines to support appeals and resolutions.
• Prioritize denial inventory based on financial impact and filing deadlines.
• Draft and submit first- and second-level appeals with supporting documentation.
• Follow up with payers to ensure timely review and adjudication of appeals.
• Maximize reimbursement through corrections and reconsideration requests.
• Monitor aging denial accounts and track recovery of revenue.

Connaissances

Denial management

EHR systems

Microsoft Excel

Coding guidelines

Payer portals

Revenue cycle software

Appeal writing

Formation

Bachelor’s degree

Outils

Denial management software

Payer portals

Description du poste

REVENUE CYCLE DENIALS SPECIALIST

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 specifically denial management (denied claims inventory/collection)
• 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.
• Technical 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