Senior Denials & Appeals Lead — Night Shift (Onsite)

John Clements Consultants, Inc.; Quezon City; On-site; PHP 700,000 - 1,100,000; Full time

Job summary

John Clements Consultants, Inc. is seeking a Senior Revenue Cycle Leader to oversee Denials and Appeals Specialists across clinic, surgical, and workers’ compensation services.

The role focuses on guiding denial resolution, payer disputes, and reimbursement issues while leveraging data to reduce revenue loss. The ideal candidate has 5+ years in healthcare revenue cycle with leadership experience, strong analytical skills, and proficiency in EMR systems.

Qualifications

• Bachelor's degree in a relevant field.
• 5+ years of progressive healthcare revenue cycle experience including denial management, insurance AR, payer follow-up, corrected claims, reconsiderations, and appeals.
• At least 2 years in a leadership role.
• Advanced experience researching and resolving complex payer denials and reimbursement issues across multiple payer types and service lines.
• Experience providing day-to-day leadership, guidance, training, mentoring, or operational support to Revenue Cycle team members.
• Experience utilizing reporting platforms or BI tools to monitor Revenue Cycle performance, analyze trends, and communicate findings.
• Experience using an Electronic Medical Record (EMR).
• Willing to work onsite (Bridgetowne, Quezon City) with night shift schedule.

Responsibilities

• Provide day-to-day operational oversight, direction, and support to Denials and Appeals Specialists handling clinic, surgical, ancillary, and Workers’ Compensation claim edits, denials, corrected claims, reconsiderations, appeals, and payer follow-up.
• Serve as the technical resource for complex or high-value denials, payer disputes, reimbursement issues, and escalations.
• Monitor denial trends, root causes, payer issues, aging accounts, and financial impact to identify opportunities to reduce preventable revenue loss.
• Analyze denial performance using data warehouse and reporting tools, and provide regular reports and recommendations to Revenue Cycle leadership.
• Monitor team productivity, quality, work queues, account aging, follow-up timeliness, and appeal deadlines.
• Conduct quality reviews and provide coaching, training, and technical guidance to improve accuracy, productivity, and compliance.
• Research complex denials and determine appropriate resolution, including corrected claims, reconsiderations, appeals, disputes, and payer escalations.
• Collaborate with Coding, Authorization, Credentialing, Managed Care, Clinical, Revenue Cycle, and Operations teams to resolve issues affecting claims and reimbursement.

Skills

Leadership

Denial management

Payer follow-up

Data analysis

BI tools

EMR

Revenue cycle

Education

Bachelor's degree

Tools

Data warehouse

Reporting tools

Job description

John Clements Consultants, Inc. is seeking a Senior Revenue Cycle Leader to oversee Denials and Appeals Specialists across clinic, surgical, and workers’ compensation services.

The role focuses on guiding denial resolution, payer disputes, and reimbursement issues while leveraging data to reduce revenue loss. The ideal candidate has 5+ years in healthcare revenue cycle with leadership experience, strong analytical skills, and proficiency in EMR systems.