Healthcare Denials Auditor — QA & Process Optimizer (Night Shift)

Manatal; Pateros; On-site; PHP 900,000 - 1,300,000; Full time

Benefits offered by this job

Healthcare coverage from day one

Dependent coverage

Paid time off with cash conversion

Group life insurance

Performance bonuses

Flexible work arrangements

Job summary

MicroSourcing is seeking a Utilization and Denials Management Auditor to support QA and daily operations within the Utilization Management team in the Philippines. The role involves auditing, training, and ensuring adherence to guidelines to optimize productivity and accuracy for client healthcare processes.

The ideal candidate is a BSN-educated RN with experience in Utilization Management or clinical denials, proficient in US guidelines and major EMRs, and capable of clear English

Qualifications

• BSN from an accredited program and active nursing license.

Responsibilities

• Support daily production and QA for Utilization and Denials Management.
• Assist in QA program design, auditing critical workflows.
• Monitor staff productivity and QA metrics.
• Escalate issues to Manager; coordinate with Training.
• Ensure documentation of medical diagnoses and treatments.
• Prepare training dashboards and participate in client calibration.

Skills

Utilization Mgmt

Clinical Appeals

QA Auditing

Nursing BSN

RN License

InterQual/MCG

EMR (Epic/Cerner/Meditech)

English Proficiency

Education

BSN degree

Tools

Epic

Cerner

Meditech

SharePoint

Excel

Job description

MicroSourcing is seeking a Utilization and Denials Management Auditor to support QA and daily operations within the Utilization Management team in the Philippines. The role involves auditing, training, and ensuring adherence to guidelines to optimize productivity and accuracy for client healthcare processes.

The ideal candidate is a BSN-educated RN with experience in Utilization Management or clinical denials, proficient in US guidelines and major EMRs, and capable of clear English