URGENT HIRING: Clinical Denials & Appeals Nurse (RN / USRN)
Salary: Up to PHP 75,000 (MAX) monthly
Location: Bonifacio Global City (BGC), Taguig
Schedule: Full Onsite | Night Shift
Job Overview
We are urgently looking for experienced RN/USRN professionals to join our Clinical Denials & Appeals team. This role plays a critical part in reviewing denied claims, conducting medical necessity reviews, and preparing strong, evidence‑based clinical appeals in compliance with U.S. healthcare regulations and payer guidelines.
Key Responsibilities
- Review denial cases for medical necessity and level of care
- Analyze denial reasons using InterQual or MCG guidelines
- Write clear, accurate, and persuasive clinical appeal letters
- Utilize hospital EMRs such as Epic, Cerner, or Meditech
- Track appeals through denial and appeal management systems
- Ensure timely submission and follow‑up of appeals in accordance with payer timelines
- Collaborate with internal teams to resolve complex denial issues
- Maintain complete and accurate documentation for tracking and reporting
Qualifications:
- Bachelor of Science in Nursing (BSN) graduate
- Active RN or USRN license
- At least 1 year experience in writing clinical appeals
- Minimum 3 years hospital acute care experience (Med‑Surg or similar)
- At least 2 years ICU experience
- Hands‑on experience with InterQual or MCG
- Strong knowledge of U.S. insurance and government healthcare programs
- Experience using hospital EMRs (Epic, Cerner, Meditech)
- Exposure to denial and appeal tracking systems
- Excellent English communication skills (written & verbal)
Preferred / Nice to Have
- Background in case management, utilization review, or clinical appeals
- ACMA or related certification
- Experience handling high‑volume denial and appeal cases
Why Join Us
- Competitive salary up to PHP 75,000
- Stable full onsite role in BGC, Taguig
- Opportunity to work on U.S. healthcare accounts
- Career growth within clinical and revenue cycle management
