Pasig City City Jobs Clinical Denials Representatives Position at HCM Nexus

Image HCM Nexus
  • Job vacancies posted on: 8 months ago

HCM Nexus has open a job vacancy for the domicile of Pasig City and surrounding areas as clinical denials representatives (phrn) with full time work system which will then be placed in our company office.

The candidates we need are those who have the minimum criteria of Bachelor's/College Degree & Professional License (Passed Board/Bar/Professional License Exam) and experienced and have the integrity to work in the field of Healthcare & Practitioner/Medical Asst.

Our company highly values a professional and competitive work environment, therefore, candidates are required to uphold honesty and discipline in a work environtment.

As a professional company, we offer a competitive monthly base salary ₱16,000 - ₱38,000 which can be adjusted by the decision of our HRD company and adjusts to the capabilities of the candidate offers for our company.

Job Info

Company HCM Nexus
Position Clinical Denials Representatives
Region Pasig City
Work Level 1-4 Years Experienced Employee
Work experience 3 years
Qualification Bachelor's/College Degree, Professional License (Passed Board/Bar/Professional License Exam)
Type of work Full-Time
Specialization Required Healthcare, Practitioner/Medical Asst
Minimum Salary PHP 16.000
Maximum Salary PHP 38.000

Job Summary:

Clinical Denial Representative is responsible to review patients medical claim when resolving edits for compliance (prior billing) and issues on rejections(rejected by the payor) in the physician side. Clinical Denial Representative must understand and comply with federal and state coding and billing regulation. The Clinical Denial Representative must ensure the confidentiality and privacy of information.

Essential Functions:

1. Prepare and process accounts timely and accurately based on client requirement.

2. Review daily account/edit reports from work queues and/or in external billing software and makes necessary corrections or resolve edits to allow electronic submission.

a. Resolving edits prior billing (Compliance)

b. Resolving rejections from the payor (Rejection)

3. Reviews and make appropriate actions such as but not limited to: a. Medical Necessity edits,

a. Medical Necessity edits,

b. Local Coverage Determination (LCD) and National Coverage Determination (NCD) edits

c. National Correct Coding Initiative (NCCI) edits

d. Modifier edits

e. Payer specific edits

f. Medically Unlikely Edits (MUE)

g. Procedure to Procedure (PTP) edits

h. Diagnosis issue

4. Enter appropriate account notes into the billing system to clarify actions taken to reconcile claims.

5. Maintains confidentiality of patient records at all times Observes HIPAA compliance.

6. Perform as a team player.

7. Use logic, critical thinking and reasoning to identify the strengths and weaknesses of alternative solutions to problems.

8. Understand the effects of new information for both current and future problem-solving and decision-making.

9. High attention to detail

10. Attendance in accordance with company HR and department policies

11. Other tasks/functions that may be assigned by the company as per business requirement; these may change from time to time to reflect the changing requirement of your position and our business

Education/Experience Requirements:

1. Bachelor of Science in Nursing graduate or Medical Allied Health Course

2. Preferably with work experience in

a. Revenue Cycle (medical coding) experience.

b. Knowledge of medical and billing terminologies, ICD-10 diagnosis coding guidelines, CPT procedures.

c. Clinical or Hospital setting Certification/licensure:

Certification is required

  • AAPC Coding Certification: CPC, COC, CIC
  • AHIMA Coding Certification: CCA, CCS-P, CCS

Work from Home Set-up

PHRN up to 60k with signing bonus of 50k!

Certified Coder up to 80k with signing bonus 80k!

Office/Company Address

Country Philippines
Region National Capital Region
City Pasig City
Map Google Map


  • Get work experience
  • Bonus for overtime
  • Be taught first
  • Good work environment

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Company Description

HCM Nexus has been delivering best fit HR solutions and candidates to our clients since our humble beginnings in December 2012. It has been inspired by our dream of an organization that provides quality recruitment and HR services to clients, while helping job candidates establish and build their careers.


Our commitment to both companies and individuals has strengthened our place in the industry as a fair, reasonable, and reliable service provider. We believe in talent and passion, and that it is possible to find the job where people can be their best. Finding the best fit of solutions and people for your business drives our passion to serve.


Just like a bespoke tailor finds the right materials and determines the proper cut for a great suit, we take the time to diligently analyze the particular needs of our clients in terms of job candidates and HR interventions. Rigorous selection and careful planning ensure that the people we recommend and the services we provide actually resolve organizational problems and help you achieve your business targets.


In terms of HR and business solutions, we create programs that are APPROPRIATE, RELEVANT, and PROPERLY-SCALED to help clients succeed in their current endeavors, but always with an eye to their future horizons. We ensure that proper job matching occurs and that the HR solutions we deliver will cater not only to your present needs but also to possible future issues and developments.


HCM Nexus adheres to the principle that proper job matching ensures that both clients and candidates come out of the engagement as winners. For the clients, Success is when they get the best candidate for the position. For the candidates, Success is when they find a job that they love.

Company Info

This vacancy is suitable for those of you who live in the following areas: National Capital Region