Staff nurse
Taguig
Job Description
Posted on 23 May 2025US Registered Nurse | Denials and Appeals | Pioneer | WFH after training
Access Healthcare is looking USRN with Denials and appeals experience!
You'll be responsible for reviewing clinical documentation, analyzing payer denials, and writing appeal letters to overturn inappropriate denials.
This role requires strong analytical, clinical, and communication skills, as well as a solid understanding of insurance guidelines and medical necessity criteria.
Key Responsibilities:
- Review clinical records and insurance denial letters to determine the validity and potential for appeal.
- Prepare comprehensive and persuasive appeals letters in alignment with payer policies, medical guidelines, and regulatory standards.
- Collaborate with physicians, case managers, coders, and other healthcare professionals to gather supporting documentation.
- Monitor appeal outcomes and trends; provide feedback to improve denial management strategies.
- Maintain up-to-date knowledge of payer requirements, federal/state regulations, and clinical guidelines ( InterQual, MCG, LCD NCD )
- Ensure all documentation is accurate, timely, and compliant with HIPAA and internal policies.
Qualifications/Requirements
Qualifications:
- Must have an active USRN license
- Must have at least 1 year of hospital experience.
- At least 1 year experience in Utilization Review, Denials Management, or Appeals Writing.
- Must have experience/knowledge in Oncology
- Strong understanding of medical necessity, clinical guidelines ( InterQual, MCG, LCD NCD ) and payer requirements.
- Excellent written communication and critical thinking skills.
- Experience working with EMRs, UM software, and payer portals.
Work location
TAGUIG CITY, NCR, FOURTH DISTRICT
Remarks
Access Healthcare is looking USRN with Denials and appeals experience to be part of our PIONEER USRN TEAM!
Apply now
Providence Hospital, Inc.Quezon City, 15 km from Taguig
and supporting a satisfactory learning environment.
• Act as mentor to personnel new in the department.
TECHNICAL DUTIES
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• Responsible for basic clerical tasks such as answering phones...
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comprehensive training programs for staff involved in the denials and appeals process. The ideal candidate will have a strong clinical background, expertise in appeals management, and a passion for teaching and improving the skill set of others within...
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and support a team of nurses and analysts handling clinical denials and appeals.
• Monitor daily workload distribution and productivity, ensuring team meets quality and turnaround standards.
• Provide training and development opportunities for team members...