Technical Denials & Appeals Specialist (IP & OP)

Discover your 100% YOU with MicroSourcing!

Position: Technical Denials & Appeals Specialist (IP & OP)
Location: BGC, Taguig City
Work setup & shift: Onsite, Night shift

Why join MicroSourcing?

You'll have:

Competitive Rewards: Enjoy above-market compensation, healthcare coverage on day one, plus one or more dependents, paid time-off with cash conversion, group life insurance, and performance bonuses.

A Collaborative Spirit: Contribute to a positive and engaging work environment by participating in company-sponsored events and activities.

Work-Life Harmony: Enjoy the balance between work and life that suits you with flexible work arrangements.

Career Growth: Take advantage of opportunities for continuous learning and career advancement.

Inclusive Teamwork: Be part of a team that celebrates diversity and fosters an inclusive culture.

Your Role:

As a Technical Denials & Appeals Specialist (IP & OP), you will be responsible for managing and resolving non-clinical (technical/administrative) claim denials within the US healthcare revenue cycle, focusing on identifying root causes, correcting errors, and ensuring timely resubmissions or appeals to maximize reimbursement.

Specifically, you will:

• Review denied claims using EOB/ERA and payer portals, interpret denial reason codes (CARC, RARC) to determine root causes, and systematically categorize and document findings.
• Correct claim errors involving patient demographics, insurance information, provider details, or basic CPT/ICD coding, and resubmit corrected claims via clearinghouses or payer portals.
• Prepare and submit non-clinical appeal letters for administrative denials, integrating supporting documentation such as authorization proof, eligibility records, and timely filing evidence.
• Monitor and manage denied or unpaid claims within the A/R inventory, performing consistent payer follow-ups via phone, email, or online portals to track status.
• Communicate directly with insurance payers to clarify denial requirements and collaborate with internal billing, coding, and QA teams to resolve complex issues.
• Maintain accurate reference documentation for common denial scenarios, utilize standardized workflows for resolution, and log all communication records in detail.

What You Need:

Non-negotiables

• At least 1 year of hands-on experience in technical appeal writing, denial management, A/R follow-up, and appeals handling within US healthcare.
• Senior High School Diploma or equivalent.
• Broad Revenue Cycle Management (RCM) knowledge, including InterQual or MCG clinical guidelines, U.S. Government Programs, and Insurance Regulations.
• Strong foundational knowledge of medical billing and coding basics (ICD-10 diagnosis codes, CPT/HCPCS procedure codes, and CMS-1500/UB-04 claim forms).
• Proficiency with hospital-based Electronic Medical Records (EMR) systems such as Epic, Cerner, or Meditech.
• Excellent verbal and written English communication and customer service skills (minimum CEFR B2 level for both verbal and written).

Preferred Skills/Expertise

• Bachelor's degree in Healthcare Administration, Business Administration, Finance, Accounting, Information Management, or a related science field (Medical Technology, Pharmacy, Biology).
• High proficiency with tracking software for denials and appeals, alongside the Microsoft Office Suite (Excel, Word, PowerPoint, Outlook, SharePoint).
• Strong analytical, critical thinking, and independent decision-making skills with high attention to detail.
• Proven ability to work independently using sound judgment and discretion in a matrixed environment.

About MicroSourcing

With over 9,000 professionals across 13 delivery centers, MicroSourcing is the pioneer and largest offshore provider of managed services in the Philippines.

Our Commitment to 100% YOU

MicroSourcing firmly believes that our company's strength lies in our people's diversity and talent. We are proud to foster an inclusive culture that embraces individuals of all races, genders, ethnicities, abilities, and backgrounds. We provide space for everyone, embracing different perspectives and making room for opportunities for each individual to thrive.

At MicroSourcing, equality is not merely a slogan—it's our commitment. Our way of life. Here, we don't just accept your unique authentic self—we celebrate it, valuing every individual's contribution to our collective success and growth.

Join us in celebrating YOU and your 100%!

For more information, visit www.microsourcing.com

Terms & conditions apply.