RN Clinical Appeals Writer - Denial Expert

Our Clients; Metro Manila; On-site; PHP 380,000 - 650,000; Full time

Job summary

Our Clients is seeking a Clinical Appeals Writer in Metro Manila to review medical records, craft evidence-based appeal letters, and submit them to insurance providers to challenge denials, ensuring medical necessity and proper coding.

The ideal candidate is an RN with at least 1 year of clinical appeals writing experience, preferably within a healthcare BPO or RCM setting, with strong written communication and attention to detail.

Qualifications

• Must be a Registered Nurse with an active nursing license.
• At least 1 year of experience in clinical appeals writing.
• Strong knowledge of medical terminology and clinical documentation.
• Experience reviewing medical records and interpreting clinical information.
• Familiarity with insurance denials, medical necessity reviews, and the healthcare appeals process.

Responsibilities

• Review medical records, clinical documentation, and insurance denial letters to identify reasons for claim denials.
• Develop and write comprehensive, evidence-based clinical appeal letters to support medical necessity and appropriateness of services rendered.
• Analyze clinical information against established medical guidelines, payer policies, and applicable healthcare regulations.
• Identify discrepancies, documentation gaps, and clinical justifications that may support reconsideration of denied claims.
• Ensure appeals are accurate, complete, properly documented, and submitted within established payer deadlines.
• Collaborate with clinical reviewers, coding specialists, billing teams, and other healthcare professionals to obtain supporting documentation.
• Maintain knowledge of clinical guidelines, payer requirements, denial trends, and appeal processes.
• Monitor appeal outcomes and identify opportunities to improve appeal quality and success rates.
• Maintain confidentiality and ensure compliance with HIPAA and other applicable data privacy regulations.

Skills

RN with active license

Written communication

Analytical thinking

Attention to detail

Time management

Education

Registered Nurse license

Job description

Our Clients is seeking a Clinical Appeals Writer in Metro Manila to review medical records, craft evidence-based appeal letters, and submit them to insurance providers to challenge denials, ensuring medical necessity and proper coding.

The ideal candidate is an RN with at least 1 year of clinical appeals writing experience, preferably within a healthcare BPO or RCM setting, with strong written communication and attention to detail.