Clinical Denials Specialist

About the Job

Target SD: No later than November 3, 2026

Work Setup/Location: 100% ONSITE (BGC, Taguig)

Work Schedule: Night Shift

The Clinical Denials Specialist plays a vital role in ensuring accurate reimbursement for healthcare services by reviewing denied claims, identifying denial reasons, and appealing claim denials.

This role collaborates closely with healthcare providers to gather the documentation and clinical evidence needed to build strong appeals, analyzes denial trends across the organization, and provides feedback to revenue cycle teams to help prevent future denials. Success requires a blend of clinical knowledge, coding and reimbursement expertise, and sharp analytical and writing skills.

Duties and Responsibilities

Denial Review & Appeals

• Knows, understands, incorporates, and demonstrates the Client Core Values in all interactions with team members, clients, and stakeholders.
• Reviews denied claims to identify denial reasons and discrepancies.
• Analyzes medical records, billing documents, and payer policies to prepare appeal arguments.
• Collaborates with healthcare providers to gather additional documentation and evidence for appeals.
• Develops effective, well-supported appeal strategies to overcome denial challenges.
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