Clinical Denials Specialist

3 days ago

Work from Home, Philippines Coronis Health LLC Full time ₱300,000 - ₱600,000 per year

Clinical Denial Representative is responsible to review patient's medical claim when resolving edits for compliance (prior billing) and issues on rejections(rejected by the payor) in the physician side. Clinical Denial Representative must understand and comply with federal and state coding and billing regulation. The Clinical Denial Representative must ensure the confidentiality and privacy of information.

Key Responsibilities

  1. Prepare and process accounts timely and accurately based on client requirement.

  2. Review daily account/edit reports from work queues and/or in external billing software

and makes necessary corrections or resolve edits to allow electronic submission.

  • a. Resolving edits prior billing (Compliance)

  • b. Resolving rejections from the payor (Rejection)

  • Reviews and make appropriate actions such as but not limited to:

  • a. Medical Necessity edits,

  • b. Local Coverage Determination (LCD) and National Coverage Determination (NCD)
  • edits
  • c. National Correct Coding Initiative (NCCI) edits
  • d. Modifier edits
  • e. Payer specific edits
  • f. Medically Unlikely Edits (MUE)
  • g. Procedure to Procedure (PTP) edits

  • h. Diagnosis issue

  • Enter appropriate account notes into the billing system to clarify actions taken to

reconcile claims.

  1. Maintains confidentiality of patient records at all times Observes HIPAA compliance.

  2. Perform as a team player.

  3. Use logic, critical thinking and reasoning to identify the strengths and weaknesses of

alternative solutions to problems.

  1. Understand the effects of new information for both current and future problem-solving

and decision-making.

  1. High attention to detail

  2. Attendance in accordance with company HR and department policies

  3. Other tasks/functions that may be assigned by the company as per business

requirement; these may change from time to time to reflect the changing requirement

of your position and our business

Qualifications:

  • Bachelor of Science in Nursing or Medical Allied Health Course.
  • Preferred experience in revenue cycle (medical coding), knowledge of ICD-10, CPT procedures, and clinical or hospital settings.
  • Certification required: AAPC (CPC, COC, CIC) or AHIMA (CCA, CCS-P, CCS).
  • Willingness to work on temporary work from home set-up.

Job Type: Full-time

Benefits:

  • Paid training

Work Location: Remote

  • Billing Denials Management Specialist

    1 week ago

    Work from Home, Philippines RML-PH Full time ₱400,000 - ₱600,000 per year

    Billing Denials Management Specialist Location: Remote Department: Billing Reports To: Denial Billing Team Lad Salary: 35, ,000 phpAbout Us:RML-PH is a dynamic and innovative Health Solutions and Care Delivery Organization committed to transforming the healthcare landscape. With a mission to provide accessible, high-quality healthcare services and...

  • Coding Denials Specialist

    3 days ago

    Work from Home, Philippines Coronis Health LLC Full time

    Coding Denials Representative is responsible to review payor's denial and identify the root cause of the denials account. Coding Denial Representative determines if the account is appealable or not. Coding Denial Representative must understand and comply with the process established by the Federal and State regulations, Payor's specific guidelines, Official...

  • clinical coordinators

    1 week ago

    Work from Home, Philippines Cliniqon Full time ₱720,000 - ₱960,000 per year

    Clinical Coordination for Open ItemsObjective:Ensure timely resolution of clinical documentation and QA-related open items to support compliance, operational efficiency, and downstream processes.Proposal:Hire 1 Full-Time Employee (FTE) for a Clinical Coordinator role dedicated to managing open clinical items.Key Responsibilities:Run a standardized weekly...

  • Spanish-Speaking Clinical Support Specialist

    1 day ago

    Work from Home, Philippines Serenity Operations Services Full time $10,800 - $15,600 per year

    Spanish-Speaking Clinical Support SpecialistWork From Home | U.S. Medical Clinic | Night ShiftSalary: USD $900–$1,300 per monthWe are looking for a Spanish-speaking Clinical Support Specialist with experience working in a U.S.-based medical clinic. This role involves supporting patient interactions, administrative tasks, scheduling, and general clinic...

  • Medical AR Specialist

    3 days ago

    Work from Home, Philippines Arizona Pain Treatment Centers PC Full time ₱233,440 - ₱243,200 per year

    About UsPain Arizona is a growing network of interventional pain management clinics dedicated to providing exceptional patient care across the Valley. We pride ourselves on professionalism, teamwork, and efficiency — and we're looking for a motivated and detail-oriented Medical AR Specialist to join our billing team.Position OverviewThe Medical Accounts...

  • Clinical Documentation Integrity

    3 days ago

    Work from Home, Philippines Neolytix LLC Full time ₱360,000 - ₱600,000 per year

    Job Opening: Clinical Documentation Integrity (CDI) SpecialistLocation: Eastwood, Quezon City (Remote / Hybrid)Company: NeolytixEmployment Type: Full-TimeDepartment: Healthcare Operations / Clinical QualityAbout NeolytixNeolytix is a tech-enabled healthcare services company delivering impactful solutions in medical billing, credentialing, contact center...

  • Clinical Lead Generation Specialist

    3 days ago

    Work from Home, Philippines Ferry Health Full time

    Location: Remote (Philippines)Schedule: Monday–Friday, 9:00 AM – 5:00 PM ESTCompensation: ₱35,000–₱45,000 base salary, plus monthly performance incentivesEmployment Type: Full-time contractor (40 hours weekly)About Ferry HealthFerry Health is a U.S.-based healthcare startup helping patients navigate the world of medical practices, providers, and...

  • Credentialing Specialist and Billing Specialist

    1 day ago

    Work from Home, Philippines 3Bs Blended Beauty & Barber Full time ₱38,360 - ₱45,840 per year

    Position Summary:We are seeking an experienced credentialing and billing specialist with expertise in medical billing, insurance claims processing, rejections management, and provider credentialing. The ideal candidate must be detail-oriented, organized, and knowledgeable in navigating payer requirements to ensure timely and accurate reimbursements and...

  • Home Health Quality Assurance Specialist

    3 days ago

    Work from Home, Philippines Narrable Full time ₱108 - ₱627 per year

    About NarrableAt Narrable, we're on a mission to improve healthcare for the 82 million senior patients in their homes. As more Americans age, the demand for more convenient forms of healthcare continues to grow—with a majority of senior Americans preferring at-home treatment. And yet, existing software solutions for care providers are outdated and...

  • ECW Specialist

    1 day ago

    Work from Home, Philippines Serenity Operations Services Full time $8,640 - $10,800 per year

    ECW Specialist (eClinicalWorks) + IT Support BackgroundWork From Home | U.S. Medical Clinic | Night ShiftSalary: USD $700–$900 per monthWe are looking for a detail-oriented and tech-savvy ECW Specialist with a strong IT support background to join our team. This role supports a U.S.-based medical clinic and requires hands-on experience with eClinicalWorks...