job description
Are you a passionate Clinical Nurse Specialist with expertise in denials and appeals management? Join MicroSourcing in beautiful Bali and play a pivotal role in ensuring patients receive the care they deserve while optimizing revenue cycle performance for healthcare providers.
In this onsite, night-shift position, you will leverage your clinical knowledge and analytical skills to review denied claims, identify root causes, and develop compelling appeals to overturn unjustified rejections. Your work will directly impact patient access to care and the financial health of healthcare organizations.
We celebrate your expertise and dedication—because your 100% effort drives 100% success. If you thrive in a dynamic environment where precision and advocacy meet, this is your opportunity to make a difference in a growing, international team.
Responsibility
- Review and analyze denied medical claims to determine the validity of payer rejections and identify trends or systemic issues.
- Develop and submit detailed, evidence-based appeals to insurance companies, Medicare/Medicaid, and other payers to overturn denials.
- Collaborate with clinical teams, coders, and billing specialists to gather supporting documentation for appeals.
- Monitor and track appeals progress, ensuring timely follow-ups and compliance with payer deadlines.
- Educate internal stakeholders on denial prevention strategies and best practices for accurate claim submission.
- Maintain up-to-date knowledge of payer policies, healthcare regulations, and coding guidelines (e.g., ICD-10, CPT).
- Generate reports on denial trends, appeal success rates, and revenue recovery for leadership review.
- Provide night-shift coverage to ensure 24/7 support for time-sensitive appeals and urgent cases.
Qualifications
- Active RN license (Indonesian or international equivalent) with 3+ years of clinical nursing experience.
- Proven experience in medical claims review, denials management, or revenue cycle operations.
- Strong understanding of healthcare reimbursement models, insurance policies, and appeal processes.
- Proficiency in medical terminology, coding (ICD-10, CPT), and EHR/EMR systems.
- Excellent written and verbal communication skills for crafting persuasive appeals and collaborating with cross-functional teams.
- Analytical mindset with the ability to interpret data, identify patterns, and propose solutions.
- Ability to work independently during night shifts with minimal supervision.
- Familiarity with U.S. healthcare systems (a plus for international clients).