Denials and Appeals Specialist

Work Location: Bridgetowne, Quezon City
Work Setup: Onsite
Shift: Night Shift
Department: Corporate – Revenue Cycle Management

Job Description

We are looking for a Denials and Appeals Specialist to handle post-service healthcare payer denials for clinic and surgical services. The role focuses on researching denials, preparing appeals and corrected claims, coordinating with internal teams, and following through until resolution.

Key Responsibilities

• Review and research payer denials and determine the appropriate resolution.
• Prepare and submit corrected claims, reconsiderations, and written appeals with supporting documentation.
• Conduct payer follow-ups and monitor accounts through final resolution.
• Review claim history, payer policies, remittance information, and account documentation.
• Use payer portals, EMR/practice management systems, and other RCM tools to research and resolve denials.
• Coordinate with Coding and other Revenue Cycle teams for coding, authorization, eligibility, documentation, and other denial issues.
• Maintain accurate documentation and ensure timely action based on payer filing and appeal deadlines.
• Identify recurring denial trends and assist in denial prevention and process improvement.

Qualifications

• 3+ years of healthcare RCM experience, preferably in denial management, medical billing, insurance follow-up, or AR.
• Hands-on experience researching and resolving payer denials.
• Experience with corrected claims, reconsiderations, appeals, and payer follow-ups.
• Familiarity with EMR, practice management, pat