Clinical Denials Specialist

4 days ago


Work from Home, Philippines Coronis Health LLC Full time ₱80,000 - ₱120,000 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



  • 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...


  • Work from Home, Philippines Coronis Health LLC Full time ₱900,000 - ₱1,200,000 per year

    Clinical Appeals Specialist is responsible in writing a compelling and effective appeal based on the clinical Documentation, payer-specific policies and is compliant to Federal and State policies. The Clinical Appeals Specialist is responsible for appeals and follow-up on clinical denials, providing appropriate denial information to be submitted to...


  • Work from Home, Philippines Coronis Health LLC Full time ₱1,200,000 - ₱2,400,000 per year

    JOB SUMMARY:The Clinical Appeals Nurse is responsible for creating a convincing and effective appeal based on clinical documentation, payer-specific standards, and compliance with federal and state policies. The Clinical Appeals Nurse is responsible for clinical denial appeals and follow-up, providing appropriate denial information to departments to ensure...


  • Work from Home, Philippines Uplift Healthcare Solutions Full time ₱480,000 - ₱600,000 per year

    Work Setup: Permanent Work-from HomeSchedule: Graveyard Shift (CST)Employment Type: Independent ContractorSalary: Php 45,000–Php 50,000 per month (depending on experience)Equipment Provided: Company-issued desktopTechnical Requirements:Personal laptop/desktop (will serve as a backup when needed)Main and backup internet connection (minimum 50 Mbps)Job...


  • Work from Home, Philippines The Perfect Child LLC Full time ₱900,000 - ₱1,200,000 per year

    We are seeking a detail-oriented and dependable Authorizations Specialist to join our healthcare management team. The ideal candidate will be responsible for obtaining, tracking, and verifying insurance authorizations for medical services, ensuring timely approvals and compliance with payer requirements. This role is critical to supporting patient access to...


  • Work from Home, Philippines Cliniqon Full time ₱400,000 - ₱480,000 per year

    Dental Claims Processing and Payment Posting SpecialistSkills & Qualifications:Knowledge of dental billing procedures, CDT coding, and insurance guidelines.Experience with dental practice management software (e.g., Dentrix,).Strong attention to detail and organizational skills.Excellent communication and problem-solving abilities.Familiarity with HIPAA and...


  • Work from Home, Philippines Staff4Me Full time ₱600,000 - ₱1,200,000 per year

    The ideal candidate for this position will have a strong background in Outpatient Physical Therapy Medical Billing, Account Follow-Up, and Posting.Primary Responsibilities: Billing out primary & secondary claims within 24 hours of receipt.EMR system reporting to accounting (experience with A2C, Therabill, TheraOffice, Prompt, and WEBPT...


  • Work from Home, Philippines Cliniqon LLC Full time ₱80,000 - ₱120,000 per year

    We are a dynamic and growing dental organization committed to delivering exceptional patient care across all our offices. As we expand, we are seeking a detail-oriented and experienced Dental Claims Processing & Payment Posting Specialist to join our team and support the financial and administrative operations across multiple...


  • Work from Home, Philippines Staff4Me Full time ₱900,000 - ₱1,200,000 per year

    Job Summary: The Medical Billing Manager is responsible for overseeing and managing the billing operations within the healthcare organization. This role involves leading the billing team, ensuring accuracy in billing procedures, optimizing revenue cycle processes, and maintaining compliance with healthcare regulations. The Medical Billing Manager will...


  • 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...