Clinical Reviewer Specialty (CRS)
Target SD: No later than November 1, 2026
Work Setup/Location: ONSITE / BGC, Taguig within 6 months then transfer to Bridgetowne, QC
Work Schedule: Night Shift
The Clinical Reviewer Specialist plays a critical role in maximizing healthcare reimbursement by reviewing denied claims, identifying root causes of denials, and developing clinically and technically sound appeal strategies.
This position reviews medical records, coding and billing documentation, payer policies, and other relevant clinical information to determine the validity of denials and identify opportunities for reimbursement recovery. The Clinical Reviewer Specialist collaborates with healthcare providers and revenue cycle teams to obtain supporting documentation, develop persuasive appeals, and address recurring denial patterns.
The successful candidate will combine clinical expertise, coding and reimbursement knowledge, analytical ability, and strong written and verbal communication skills to support both revenue recovery and denial prevention initiatives.
This is a work-from-office opportunity for a clinically credentialed professional seeking to make a measurable impact on financial performance, claim quality, and revenue cycle outcomes.
Duties and Responsibilities:
Denial Review & Appeals
- Demonstrate
