A PHRN - Clinical Denials and Appeals reviews denied insurance claims, analyzes the reasons for denial, and prepares appeals using their clinical expertise. They gather medical documentation, work with healthcare providers, and submit appeals to insurance companies, ensuring the care provided meets medical necessity criteria. This role involves clear communication with insurers to dispute denials and advocate for claim approval.
Work Setup:
Work onsite - BGC Taguig`
Graveyard shift - 9PM to 6AM
Weekends off
Salary and Benefits:
Package - 40,000 to 55,000
10% Night differential
Qualifications:
Active Philippine Registered Nurse (PHRN) license.
Minimum of 1 year of hospital experience in critical care (e.g., Oncology, ER, OR).
At least 6 months of experience as a Clinical Denials and Appeals Specialist in a BPO setting.
Willingness to work onsite and during graveyard shifts.
