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Clinical Denials Specialist

2 weeks ago

Manila, National Capital Region, Philippines Access Healthcare Services Manila, Inc. Full time

Access Healthcare Services Manila, Inc. is looking for a skilled Registered Nurse to assume a critical role in our team.

The ideal candidate will be responsible for ensuring the completion of assigned patient cases by performing advanced level work related to clinical denial and utilization management.

Key Responsibilities:

  • Manage medical denials by conducting comprehensive reviews of clinical documentation.
  • Handle audit and compliance responsibilities, as well as other administrative duties as required.
  • Write compelling arguments based on clinical documentation and submit appeals in a timely manner.
  • Actively manage denial or appeal activity and report emerging trends related to payer denials to Revenue Cycle management.

Requirements:

  • A registered nurse with an active license.
  • 1-3 years of experience in a hospital bedside/acute care/clinical setting.
  • Experience in healthcare BPO account management is a plus.
  • Ability to work in a fast-paced environment and meet deadlines.
  • Strong communication and analytical skills.

We are seeking a highly motivated and organized individual to join our team.