Clinical Denials Resolution Expert

1 month ago


Pasig, National Capital Region, Philippines Visaya KPO Full time

Visaya KPO is seeking a highly skilled Clinical Denials Resolution Expert to join our team in Ortigas, Pasig City. This is a full-time position that requires expertise in medical collections, denials, and appeals.

About the Role

We are looking for an experienced professional with a strong background in clinical denials resolution. As a Clinical Denials Resolution Expert, you will be responsible for researching and resolving unpaid or denied claims, verifying patient demographics and insurance information, and ensuring timely filing deadlines.

Key Responsibilities
  • Research and resolve unpaid or denied claims, including DRG downgrades, level of care, coding, and medical necessity issues
  • Verify patient demographics and insurance information through payer websites, client eligibility systems, or via phone with insurance carriers/providers
  • Update patient records and insurance information in relevant systems
  • Monitor claims for missing information, authorization, and control numbers (ICN/DCN)
  • Research Explanation of Benefits (EOBs) for payments or adjustments to resolve claim discrepancies
  • Contact payers via phone or written correspondence to secure payment of claims, reconsideration, and appeal submission
  • Access client systems for payment, patient, claim, and data information
  • Familiarity with Epic tool and intermediate knowledge of ICD-10, CPT, HCPCS, and NCCI
Requirements & Competencies

To be successful in this role, you must have:

  • 3+ years of experience in medical collections, denials, and appeals
  • At least 6 months of experience with Epic tool
  • Intermediate knowledge of third-party billing guidelines, billing claim forms (UB04/1500), and payor contracts (commercial and government)
  • Intermediate working knowledge of Microsoft Word and Excel
  • Intermediate knowledge of health information systems (EMR, Claim Scrubbers, Patient Accounting Systems, etc.)
  • Intermediate knowledge of DDE Medicare claim system and government rules and regulations
Benefits and Perks

As a Visaya KPO employee, you will enjoy the following benefits:

  • 15% Night Differential
  • HMO Benefits after 30 days + Add Up to 2 Dependents
  • Retirement Benefits
  • 24 Leave Credits per year, Convertible to Cash
  • Wholistic Employee Wellness Program

The estimated salary for this position is PHP 70,000 - 90,000 per month, depending on experience and qualifications.



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