PHRN Appeals Denial

Gratitude Inc

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6 days ago

PHRN Appeals Denial

2-10 Year(s)

45 - 50 Thousand p.m

Manila (Bridgetown quezon City)

Job Description

Key Skills

PHRN Utilization Management Clinical Denials and appeals

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Job Title: PHRN Appeals Denials

Shift: Night shift

Work Set-up: Onsite in Bridgetowne, Quezon City

Salary range: 50,762 package (Basic:43,762 and Allowance: 7K) with signing bonus to be released on their first payout for those who can join on Dec 9th/Immediately

Target Start Date: December 9, 2025

Headcount: 12

Recruitment Process: Virtual

QUALIFICATIONS:

• An active Philippine Registered Nurse (PHRN) with license required

• Minimum of 1 year of clinical nursing experience (Hospital, Clinic, or Managed Care Setting) with 6 months minimum of Clinical Process Outsourcing Experience and Background Handling Clinical Role (s) focusing on Clinical Appeals and Denials, Utilization Management and other related functions

• With InterQual experience is a plus

• Strong clinical knowledge particularly in Medical Necessity Review and Interpretation of Clinical Documentation

• Good knowledge and understanding of different Healthcare Insurance Processes, Appeals, Grievances, and Utilization Management is preferred

• Demonstrates excellent verbal and written communication skills, strong attention to detail and case documentation practice.

• Ability to manage multiple cases and meet regulatory turnaround time under pressure

• Proficient in basic MS Office applications such as Word, Excel, and Outlook

• Willing to work on Flexible schedules including US Hours and Holidays

•

Preferred Qualifications:

• Experience handling Medicare Part C or US-based appeals cases

• Familiarity with CMS Guidelines, NCQA Standards or URAC Regulations

Experience in using Appeals Management Platforms and Salesforce Health Cloud

Role

Nursing - Management

Timings

Night Shift (Permanent)

Industry

BPO

Work Mode

Work from office

Functional Area

Medical Professional / Healthcare Practitioner / Technician

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