US Healthcare Appeals Specialist (Technical) | Onsite, Night shift

MicroSourcing; Taguig; On-site; PHP 446,000 - 781,000; Full time

Benefits offered by this job

Healthcare coverage Day 1

PTO with cash conversion

Life insurance

Performance bonuses

Job summary

MicroSourcing in the Philippines seeks a US Healthcare Appeals Specialist (Technical) to manage non-clinical denials within the US revenue cycle. You will analyze root causes, correct issues, prepare appeals, and work with payers and internal teams to maximize reimbursement and reduce denials.

With over 9,000 professionals, MicroSourcing offers Day 1 healthcare coverage, PTO with cash conversion, life insurance, and performance bonuses in a collaborative, inclusive environment.

Qualifications

• Experience in technical denials and appeals within US healthcare revenue cycle.
• Knowledge of CARC/RARC denial codes and claim validation processes.
• Familiarity with HIPAA and payer portals is preferred.

Responsibilities

• Review denied claims using EOBs, ERAs, and payer portals to identify denial reasons.
• Interpret denial codes and categorize denials (authorization, eligibility, coding).
• Prepare and submit non-clinical appeal letters with documentation.
• Monitor appeal status and perform timely follow-up for resolution.
• Collaborate with billing, coding, QA and internal teams to resolve issues.

Skills

Denials management

Accounts Receivable

Appeals handling

Medical billing

English comms

Education

Senior High School Diploma

Bachelor's degree preferred

Tools

Epic

Cerner

Meditech

MS Office

Job description

Discover your 100% YOU with MicroSourcing!

Position: US Healthcare Appeals Specialist (Technical)

Location: BGC, Taguig City

Work setup & shift: Onsite | Night Shift

Why join MicroSourcing?

You'll Have

Competitive Rewards:

Enjoy above-market compensation, healthcare coverage on Day 1 for you and one or more dependents, paid time off with cash conversion, group life insurance, and performance bonuses.

A Collaborative Spirit:

Contribute to a positive and engaging work environment by participating in company-sponsored events and activities.

Work-Life Harmony:

Enjoy the balance between work and life that suits you with flexible work arrangements.

Career Growth:

Take advantage of opportunities for continuous learning and career advancement.

Inclusive Teamwork:

Be part of a team that celebrates diversity and fosters an inclusive culture.

Your Role

As a US Healthcare Appeals Specialist (Technical), you will manage and resolve non-clinical (technical and administrative) claim denials within the US healthcare revenue cycle. You will analyze denial root causes, correct claim issues, prepare technical appeals, and collaborate with payers and internal stakeholders to maximize reimbursement and reduce claim denials.

Specifically, You Will

• Review denied claims using EOBs, ERAs, and payer portals to identify denial reasons and root causes.
• Interpret denial reason codes (CARC/RARC) and categorize denials, including authorization, eligibility, coding, and timely filing issues.
• Correct claim errors related to patient demographics, insurance information, provider details, authorizations, and basic CPT/ICD coding validation.
• Prepare and submit non-clinical appeal letters with supporting documentation, including authorization records, eligibility verification, and timely filing evidence.
• Monitor appeal status and perform timely follow-up to ensure successful claim resolution.
• Manage denied and unpaid claims within the Accounts Receivable (A/R) inventory through payer follow-up via phone, email, and payer portals.
• Collaborate with billing, coding, quality assurance, and other internal teams to resolve complex denial issues.
• Maintain accurate documentation, claim notes, communication logs, and denial tracking reports while supporting continuous process improvement initiatives.

What You Need

Non-negotiables

• Minimum of 1 year of experience in technical denials, denial management, accounts receivable follow-up, appeals handling, or technical appeal writing within the US healthcare revenue cycle.
• Senior High School Diploma or equivalent.
• Working knowledge of U.S. healthcare revenue cycle management and medical billing processes.
• Knowledge of ICD-10 diagnosis codes, CPT/HCPCS procedure codes, CMS-1500 and UB-04 claim forms, and CARC/RARC denial codes.
• Familiarity with InterQual or MCG clinical guidelines and U.S. government healthcare programs and insurance regulations.
• Experience using hospital EMR systems such as Epic, Cerner, or Meditech.
• Excellent written and verbal English communication skills (minimum CEFR B2).
• Strong analytical, problem-solving, organizational, and time management skills with exceptional attention to detail.

Preferred Skills/expertise

• Bachelor's degree in Healthcare Administration, Medical Technology, Pharmacy, Biology, Business Administration, Finance, Accounting, Information Management, or a related field.
• Experience using denial management systems and appeals tracking tools.
• Proficiency with Microsoft Office Suite (Excel, Word, PowerPoint, Outlook, and SharePoint).
• Experience communicating directly with insurance payers and resolving complex claim issues.
• Ability to work independently while managing multiple priorities in a fast-paced environment.
• Strong collaboration, critical thinking, and decision-making skills with experience working in cross-functional or matrixed teams.

About MicroSourcing

With over 9,000 professionals across 13 delivery centers, MicroSourcing is the pioneer and largest offshore provider of managed services in the Philippines.

Our commitment to 100% YOU

MicroSourcing firmly believes that our company's strength lies in the diversity and talent of our people. We are proud to foster an inclusive culture that embraces individuals of all races, genders, ethnicities, abilities, and backgrounds. We create opportunities for everyone to thrive by embracing different perspectives and fostering an inclusive workplace. At MicroSourcing, equality is more than a slogan—it's our commitment and our way of life. Here, we don't just accept your authentic self—we celebrate it, recognizing every individual's contribution to our collective success and growth.

Join us in celebrating YOU and your 100%!