Clinical Denials
3 weeks ago
Discover your 100% YOU with MicroSourcing Position: Clinical Denials & Appeals Nurse Specialist - IP & OP Location: Taguig Work setup & shift: Onsite | Night shift Why join MicroSourcing? Competitive Rewards: Enjoy above‑market compensation, healthcare coverage on day one (for you and at least one dependent), 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 Clinical Denials & Appeals Nurse Specialist (IP & OP) , you will: Review denied claims, evaluate denial reasons, and carry out the appeals process in a timely and accurate manner. Submit retro‑authorizations and conduct medical necessity reviews based on denial root causes. Prepare and submit compelling written appeals based on clinical documentation, payer policies, and contract language. Track and document all denial and appeal activities, ensuring timely follow‑up and resolution. Identify denial trends, escalate recurring issues, and recommend process improvements to reduce accounts receivable (A/R). Collaborate with management to enhance processes, ensure compliance with regulations, and maintain accurate reporting. Stay informed of federal/state regulations, payer requirements, and clinical guideline updates (InterQual, MCG). Participate in continuous improvement initiatives and professional development activities. What You Need Non-negotiables At least 1 year of clinical appeal writing experience. Minimum 3-5 years of acute care clinical experience in a hospital setting (Med/Surg or similar); 2-3 years if ICU experience. Bachelor of Science in Nursing . Registered Nurse (PHRN or USRN) with active license. Proficiency with InterQual or MCG clinical guidelines. Familiarity with U.S. government programs and insurance regulations . Experience using electronic medical records (EMR) such as Epic, Cerner, or Meditech. Preferred skills/expertise Master's degree or credential in business, healthcare, or related field. Certification in case management , clinical appeals , or clinical denials . Experience using systems for tracking denials and appeals . Proficiency in Microsoft Office Suite (Excel, Word, PowerPoint, Outlook, SharePoint). Excellent analytical, critical thinking , and communication skills. Strong attention to detail and ability to make sound decisions independently. Experience working in a matrixed environment . 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 our people's diversity and talent. We are proud to foster an inclusive culture that embraces individuals of all races, genders, ethnicities, abilities, and backgrounds. We provide space for everyone, embracing different perspectives, and making room for opportunities for each individual to thrive. For more information, visit Terms & conditions apply. #J-18808-Ljbffr
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Clinical Denials
5 days ago
Manila, National Capital Region, Philippines MicroSourcing Full time ₱1,500,000 - ₱2,500,000 per yearDiscover your 100% YOU with MicroSourcingPosition: Clinical Denials & Appeals ManagerLocation: TaguigWork setup & shift: Onsite | Night shiftWhy join MicroSourcing?You'll have:Competitive Rewards: Enjoy above-market compensation, healthcare coverage on day one (for you and at least one dependent), paid time-off with cash conversion, group life insurance, and...
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Clinical Denials
5 days ago
Manila, National Capital Region, Philippines MicroSourcing Full time ₱2,000,000 - ₱2,500,000 per yearDiscover your 100% YOU with MicroSourcingPosition: Clinical Denials & Appeals Nurse Specialist - IP & OPLocation: TaguigWork setup & shift: Onsite | Night shiftWhy join MicroSourcing?You'll have:- Competitive Rewards: Enjoy above-market compensation, healthcare coverage on day one (for you and at least one dependent), paid time-off with cash conversion,...
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Clinical Denials
7 days ago
Manila, National Capital Region, Philippines MicroSourcing Full time ₱900,000 - ₱1,200,000 per yearDiscover your 100% YOU with MicroSourcingPosition: Clinical Denials & Appeals QA SpecialistLocation: TaguigWork setup & shift: Onsite | Night shiftWhy join MicroSourcing?You'll have:Competitive Rewards: Enjoy above-market compensation, healthcare coverage on day one (for you and at least one dependent), paid time-off with cash conversion, group life...
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Clinical Denials
5 days ago
Manila, National Capital Region, Philippines MicroSourcing Full time ₱1,200,000 - ₱2,400,000 per yearDiscover your 100% YOU with MicroSourcingPosition: Clinical Denials & Appeals TrainerLocation: TaguigWork setup & shift: Onsite | Night shiftWhy join MicroSourcing?You'll have:Competitive Rewards: Enjoy above-market compensation, healthcare coverage on day one (for you and at least one dependent), paid time-off with cash conversion, group life insurance, and...
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Clinical Denials Triage Specialist
5 days ago
Manila, National Capital Region, Philippines TapTalent Full time ₱40,000 - ₱60,000 per yearWe're Hiring: Clinical Denials Triage Specialist We are seeking a detail-oriented and analytical Clinical Denials Triage Specialist. The ideal candidate will play a crucial role in reviewing, analyzing, and resolving clinical denial cases to ensure efficient revenue cycle management. Location: Philippines Work Mode: Hybrid Role: Clinical Denials Triage...
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Appeals and Denials Specialist
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Manila, National Capital Region, Philippines Recruitiere Sie Full timeJob Title: Appeals and Denials SpecialistShift: Night shiftLocation: OnsiteSalary Range: 50,762 package (Basic: 43,762 and Allowance: 7K) with a signing bonus available in the first payout for those who can join on December 9th or immediately.Target Start Date: December 9, 2025QUALIFICATIONS:Active Philippine Registered Nurse (PHRN) license required.Minimum...
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, Metro Manila, Philippines MicroSourcing Full timeDiscover your 100% YOU with MicroSourcing! Position: Clinical Documentation Improvement Nurse Specialist - IP Location: Taguig Work setup & shift: Onsite | Night shift Why join MicroSourcing? You'll have: Competitive Rewards: Enjoy above-market compensation, healthcare coverage on day one (for you and at least one dependent), paid time‑off with cash...
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Clinical Coding Analyst
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Manila, National Capital Region, Philippines Health Business Solutions Full time ₱1,200,000 - ₱1,800,000 per yearSigning Bonus for new hiresClinical Coding Analyst Health Business Solutions, LLC Manila (On-site) We are seeking a detail-oriented and analytical Clinical Coding Analyst to join our team and take on the responsibility of reviewing claims denied for coding-related issues. As a Clinical Coding Analyst, you will play a critical role in identifying and...
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Clinical Appeals Nurse
7 days ago
Ortigas, Metro Manila, Philippines Connext Global Solutions Inc Full time ₱1,200,000 - ₱2,400,000 per yearJoin Our Team as a Clinical Appeals NurseThe Clinical Appeals Nurse audits medical records to support denial reviews, utilization reviews, and defense audits. The role requires strong clinical judgment, knowledge of InterQual and MCG criteria, and the ability to write detailed appeal letters while ensuring compliance with healthcare regulations.Key...
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PHRN - Denials & Appeals Nurse
16 hours ago
Manila, National Capital Region, Philippines Global Group Innovative Services Full timeJob SummaryWe're hiring PH Registered Nurses (Client Insurance) to collaborate with healthcare providers and members to ensure quality, medically appropriate, and cost-effective care.You'll assess inpatient and outpatient medical necessity, coordinate discharge planning, and support utilization management and appeals review.ResponsibilitiesEvaluate medical...
