Revenue Cycle Denial Representative

4 days ago

Taguig, National Capital Region, Philippines First Source Solutions Limited Full time ₱900,000 - ₱1,200,000 per year

Role Description: We are seeking a detail-oriented and analytical Revenue Cycle Denial Representative to join our team. This role is responsible for managing hospital claim denials, identifying root causes, and working with payer's and internal teams to resolve and prevent future denials. The ideal candidate will have experience in hospital revenue cycle operations, insurance claim processing, and a strong understanding of payer policies and regulations.

Roles & Responsibilities

  • Review and analyze denied hospital claims to determine root causes and appropriate resolution strategies.
  • Knowledgeable resolution in top denials such as but not limited to No Authorization, Timely Filing, Coordination of Benefits, Additional Documentation Request, etc.
  • Work with payers, including Medicare, Medicaid, and Commercial insurers, to appeal and resolve denied claims.
  • Identify trends in denials and collaborate with internal departments such as coding and billing to implement corrective actions.
  • Prepare and submit appeals and reconsideration requests in compliance with payer guidelines and deadlines.
  • Maintain thorough documentation of denial reasons, appeal actions, and resolutions in the billing system.
  • Monitor payer policies and regulatory changes to ensure compliance and proactive denial prevention.
  • Communicate effectively with insurance representatives and internal leaders to expedite resolution and improve processes.
  • Assist in developing the best practices and training materials for denial management and prevention.
  • Meet departmental productivity and quality standards to optimize reimbursement and minimize revenue loss.

·       Analize account history previous actions prior to taking next action step to resolve the claim

·       Utilized resources provided by the client to promote accuracy of work events to resolve claims.

  • Understand when claim corrections and rebilling are applicable

·       Escalate claims with payers for resolution on inaccuracy and delayed processing of claims.

·       Meet specified goals and objectives assigned by management and/or Client.

  • Ensure compliance with federal, state, and payer regulations, as well as hospital policies.


•       Always maintain confidentiality of account information.


•       Adhere to the prescribed policies and procedures as outlined in the Employee Handbook and the Employee Code of Conduct.


•       Maintain awareness of and actively participate in the Corporate Compliance Program.


•       Maintain a confidential and orderly remote work area.


•       Assist with other projects as assigned by management

  • Revenue Cycle Associate

    2 weeks ago

    Taguig, National Capital Region, Philippines HRTX consulting Full time ₱1,200,000 - ₱3,600,000 per year

    Location: BGC, Taguig | Full onsiteWork Schedule: Monday to Friday | Night shift (9pm to 6am)Role OverviewThe RCM Posting Associate is responsible for accurately posting payments, adjustments, and denials from various payers, ensuring integrity in financial records and client accounts. This role plays a critical part in maintaining cash flow accuracy through...

  • Edit Resolution Analyst/ Denial Management Medical Coder

    2 weeks ago

    Taguig, National Capital Region, Philippines Tenet Global Business Center, Inc. Full time ₱1,200,000 - ₱3,600,000 per year

    This position is responsible for identifying, capturing, tracking, reviewing, and resolving held claim edits, claim rejections, and/or denials that result from the claims/billing cycle.  This position ensures all resolutions utilized are in accordance with policies, procedures, official coding guidelines/advice, rules and regulations (payer, state, and/or...

  • Assistant Manager – Revenue Cycle Management/Denials

    2 weeks ago

    Taguig, National Capital Region, Philippines First Source Solutions Limited Full time ₱900,000 - ₱1,200,000 per year

    Job Title: Manager – Receivables / Revenue CycleAbout FirstsourceFirstsource Solutions is a leading provider of customized Business Process Management (BPM) services. Firstsource specialises in helping customers stay ahead of the curve through transformational solutions to reimagine business processes and deliver increased efficiency, deeper insights, and...

  • SPE-Revenue Cycle Mgmt LS

    2 weeks ago

    Taguig, National Capital Region, Philippines Cognizant Full time $104,000 - $130,878 per year

    Job SummaryJoin our team as a Specialist in Revenue Cycle Management where you will leverage your expertise in Accounts Receivables and Provider domains. With 2 to 4 years of experience you will play a crucial role in optimizing financial processes. This office-based night shift position offers the opportunity to make a significant impact on our companys...

  • Edit Resolution Analyst

    2 weeks ago

    Taguig, National Capital Region, Philippines Conifer Health Solutions Full time ₱800,000 - ₱1,200,000 per year

    This position is responsible for identifying, capturing, tracking, reviewing, and resolving held claim edits, claim rejections, and/or denials that result from the claims/billing cycle. This position ensures all resolutions utilized are in accordance with policies, procedures, official coding guidelines/advice, rules and regulations (payer, state, and/or...

  • Team Leader

    4 days ago

    Taguig, National Capital Region, Philippines Nezda Technologies, Inc. Full time ₱900,000 - ₱1,200,000 per year

    Position: Team Leader (RCM Healthcare)Location McKinley TaguigSchedule: Night ShiftSetup: OnsiteEmployment: Fulltime / Regular Job DescriptionResponsible for managing and supervising a team of RCM associates handling end-to-end revenue cycle processes, such as patient billing, claims submission, payment posting, denial management, and accounts receivable...

  • Collections Representative-US Healthcare Account

    2 weeks ago

    Taguig, National Capital Region, Philippines Systemantech Full time ₱360,000 per year

    We're Hiring: Collections RepresentativeSalary: Up to PHP 30,000Schedule: Shifting | Night ShiftLocation: BGC taguigStart Date: ASAP | HMO Day 1 | 10 SLsAbout the Role:Are you experienced in handling healthcare revenue cycle management and insurance claims? Join our team as a Collections Representative and be part of a dynamic environment where you'll play a...

  • Assistant Operations Manager – Receivables

    2 weeks ago

    Taguig, National Capital Region, Philippines BIITECH, LLC Full time ₱750,000 - ₱900,000 per year

    Assistant Operations Manager – Receivables / Revenue CycleLocation: Onsite – McKinley Hill, TaguigSchedule: Rotating shiftsSalary: PHP 60,000 – 75,000 (basic) plus PHP 2,000 allowanceReporting to: Director – OperationsAbout the RoleWe are seeking an experienced Assistant Operations Manager – Receivables / Revenue Cycle to lead and support our...

  • Clinical Authorization Specialist

    4 days ago

    Taguig, National Capital Region, Philippines AGS health Full time ₱1,200,000 - ₱2,400,000 per year

    Job Title: Clinical Authorization SpecialistLocation: McKinley, Taguig CityWork Set-up: OnsiteOUR COMPANY:AGS Health is more than a revenue cycle management company–we're a strategic partner for growth. With expert services complemented by AI-enabled technologies and high-touch support, AGS Health is the premier revenue cycle partner for leading health...

  • RCM Cash Posting Associate

    2 weeks ago

    Taguig, National Capital Region, Philippines Private Advertiser Full time ₱38,000 per year

    Key Responsibilities• Accurately post patient payments, insurance payments, adjustments, and denials into the billing system.• Review and reconcile payment documentation.• Research, resolve, and reallocate unapplied or misapplied cash.• Maintain accuracy and timeliness in daily posting activities to meet revenue cycle goals.• Coordinate with...