PHRN Appeals Denial
Gratitude IncPHRN Appeals Denial
Job Description
Key Skills
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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
Note: Myglit doesn't charge any money from candidates. If you have been asked to pay money to get this job then report to us immediately at support@myglit.com.
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