Clinical Denials and Appeals Nurse

6 days ago


Pasay, National Capital Region, Philippines Access Healthcare Services Manila, Inc. Full time ₱900,000 - ₱1,200,000 per year

Access Healthcare is looking for REGISTERED NURSE to join our growing team.

You'll be ensuring the completion of assigned patient cases by doing roll calls, processing concurrent and retro clinical reviews, work processing surgery authorizations, as needed.

Responsibilities :

  • Perform advanced level work related to clinical denial and utilization management.
  • Manage medical denials by conducting a comprehensive review of clinical documentation.
  • Handle audit/compliance responsibilities and other administrative duties as required.
  • Write compelling arguments based on the clinical documentation and the medical policies of the payer and submit appeals in a timely manner.
  • Resolve charge problems to ensure accurate and complete billing, and inform staff on proper billing, follow-up, and documentation practices.
  • Review and rectify errors in third party payer reimbursement denials based on documentation, billing accuracy, medical necessity, coding, modifier, and other related issues.
  • Actively manage, maintain, and communicate denial or appeal activity to appropriate stakeholders and report suspected or emerging trends related to payer denials to Revenue Cycle management.

Qualifications :

  • Must be Registered Nurse with Active license
  • Hospital Bedside experience (OR / ER / ICU/ PACU / General Wards / After Surgery Care )
  • Experience in BPO Healthcare account is a definite advantage (Insurance, Denials & Appeals, Coding, Utilization Review, Prior Authorization, ETC )
  • Must be amenable to work onsite at Double Dragon, Pasay
  • Can start ASAP

We need talented individual like you, Apply Now



  • Pasay, National Capital Region, Philippines Access Healthcare Full time ₱420,000 - ₱540,000 per year

    Job description:Access Healthcare is looking for REGISTERED NURSE to join our growing team.You'll be ensuring the completion of assigned patient cases by doing roll calls, processing concurrent and retro clinical reviews, work processing surgery authorizations, as needed.Responsibilities :Perform advanced level work related to clinical denial and utilization...


  • Pasay, National Capital Region, Philippines access healthcare Full time ₱900,000 - ₱1,200,000 per year

    Job description:Access Healthcare is looking for REGISTERED NURSE to join our growing team.You'll be ensuring the completion of assigned patient cases by doing roll calls, processing concurrent and retro clinical reviews, work processing surgery authorizations, as needed.Responsibilities :Perform advanced level work related to clinical denial and utilization...


  • Pasay, National Capital Region, Philippines Access Healthcare Full time

    Accesshealthcare is looking for REGISTERED NURSE to join our growing team.You'll be ensuring the completion of assigned patient cases by doing roll calls, processing concurrent and retro clinical reviews, work processing surgery authorizations, as needed.Qualifications :Must be Registered Nurse with Active licenseHospital Bedside experience (OR / ER / ICU/...


  • Pasay, National Capital Region, Philippines Access Healthcare Full time

    Accesshealthcare is looking for REGISTERED NURSE to join our growing team.You'll be ensuring the completion of assigned patient cases by doing roll calls, processing concurrent and retro clinical reviews, work processing surgery authorizations, as needed.QualificationsActive PHRN licenseat least 1 year of clinical nursing experience in utilization review or...

  • PHRN for Non-Voice

    2 weeks ago


    Pasay, National Capital Region, Philippines Access Healthcare Services Manila, Inc. Full time ₱900,000 - ₱1,200,000 per year

    Access Healthcare is looking for a Utilization and Clinical Denials Nurse to join our growing clinical account. The ideal candidate is a Licensed Philippines Nurse with at least one (1) year of hospital bedside experience and a strong understanding of utilization review, clinical documentation, and denial management in a BPO set-up. This role involves...

  • PH Registered Nurse

    2 weeks ago


    Pasay, National Capital Region, Philippines access healthcare Full time ₱900,000 - ₱1,200,000 per year

    Job description:We are seeking a detail oriented and experienced Registered Nurse (RN) to join our TEAM as a Virtual Utilization Review Nurse.You'll be responsible for reviewing medical records and clinical documentation to determine the medical necessity, appropriateness, and efficiency of healthcare services provided. You'll work closely with physicians,...


  • Pasay, National Capital Region, Philippines access healthcare Full time ₱900,000 - ₱1,200,000 per year

    We are currently looking for Registered Nurse Quality Analyst to be part of our ClinicalteamThe Quality Analyst will be responsible for monitoring and evaluating the quality ofcustomer service interactions, identifying areas for improvement, and ensuringcompliance with policies and procedures. The successful candidate must be a RegisteredNurse with...

  • PHRN Clinical Trainer

    2 weeks ago


    Pasay, National Capital Region, Philippines Access Healthcare Services Manila, Inc. Full time ₱1,200,000 - ₱2,400,000 per year

    We are seeking a motivated and experienced Clinical Trainer to join our Healthcare Business Processing Outsourcing Team. In this role, you will be responsible for overseeing the clinical training programs, ensuring deployed employees possess the necessary skills and knowledge to deliver exceptional services to our clients. The ideal candidate will have a...

  • Clinical Manager

    2 weeks ago


    Pasay, National Capital Region, Philippines Access Healthcare Services Manila, Inc. Full time ₱1,500,000 - ₱2,500,000 per year

    We are currently seeking a highly skilled Registered Nurse Manager to help lead our clinical team and elevate the quality of care we provide for U.S.-based healthcare clientsJob Overview:The Clinical Manager will be responsible for overseeing and coordinating all clinical operations within our facility, ensuring that both staff and patients receive the...

  • Head Nurse

    6 days ago


    Pasay, National Capital Region, Philippines RainTree Care Services & Senior Residences Full time ₱450,000 - ₱600,000 per year

    Position Goals* Providing professional and continuous nursing care with the following goals:* Promotes and restores resident's health by completing the nursing process.* Respecting the self-care abilities, self-determination, desires and habits of the residents, with appreciation and consideration of the abilities and wishes of relatives regarding the care.*...