Discover your 100% YOU with MicroSourcing!Position: Clinical Denials & Appeals Nurse Specialist - IP & OP
Location: Taguig
Work setup & shift: Onsite | Night shift
Why join MicroSourcingYouu0027ll have:- Competitive Rewards: Enjoy above-market compensation, healthcare coverage on day one (for you and at least one dependent), 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
Clinical Denials & Appeals Nurse Specialist (IP & OP), you will:
- Review denied claims, evaluate denial reasons, and carry out the appeals process in a timely and accurate manner.
- Submit retro-authorizations and conduct medical necessity reviews based on denial root causes.
- Prepare and submit compelling written appeals based on clinical documentation, payer policies, and contract language.
- Track and document all denial and appeal activities, ensuring timely follow-up and resolution.
- Identify denial trends, escalate recurring issues, and recommend process improvements to reduce accounts receivable (A/R).
- Collaborate with management to enhance processes, ensure compliance with regulations, and maintain accurate reporting.
- Stay informed of federal/state regulations, payer requirements, and clinical guideline updates (InterQual, MCG).
- Participate in continuous improvement initiatives and professional development activities.
What You Need
Non-negotiables- At least 1 year of clinical appeal writing experience.
- Minimum 3-5 years of acute care clinical experience in a hospital setting (Med/Surg or similar
