Clinical Appeals Writer

We're Hiring: Clinical Appeals Writer!

Viventis Search Asia is working with a leading provider of technology-driven solutions that transform the patient experience and financial performance of healthcare providers. They are currently looking for talented Clinical Appeals Writer professionals to join their team in January 2025.

Location: Philippines

Shift: WFH; Dayshift; Mondays - Fridays

Training: WFH; Nightshift; 4 months

Job Description:

• Letter Composition: Draft clear, concise, and compelling appeal letters for different levels of appeals, including initial appeals, medical necessity appeals, and administrative reviews.
• Clinical Review: Conduct in-depth clinical reviews of patient records, medical guidelines, and insurance policies to gather necessary information for appeal letters.
• Collaboration: Collaborate with healthcare providers, legal teams, and patients to obtain relevant medical information and build a strong case for appeals.
• Regulatory Compliance: Stay up-to-date with healthcare laws, regulations, insurance policies, and care guidelines to ensure appeal letters comply with legal requirements and industry standards.
• Appeal Strategy: Develop effective appeal strategies based on medical necessity, insurance guidelines, and patient needs.
• Quality Assurance: Review and revise appeal letters to ensure accuracy, completeness, and effectiveness in presenting the case for approval.

Job Requirements:

• Experience: 6 months to 1 year in clinical appeals writing
• Clinical Experience: 2+ years in a hospital setting, preferably in the Emergency Room (ER), Intensive Care Unit (ICU), or Medical-Surgical units
• Education: BS Nursing graduate
• Licensing: Must have an active PHRN license
• Role: Responsible for reviewing and appealing denied claims, writing detailed and persuasive appeals, and supporting the recovery of denied insurance payments.

Ready to make an impact? Apply now and lets grow together!