Lead QA Specialist – Clinical Denials & Compliance

TASQ Staffing Solutions; Quezon City; On-site; PHP 700,000 - 1,100,000; Full time

Job summary

TASQ Staffing Solutions is seeking a QA Team Lead – Clinical Denials to lead the QA function for Clinical Denials operations. You will oversee audits, coaching, and calibration to ensure quality standards and client-specific requirements are met.

The role requires strong leadership, 4–5 years in healthcare denials or related fields, and experience in QA or supervisory roles. Onsite work with potential relocation within the region.

Qualifications

• Bachelor's degree in Nursing, Healthcare Administration, Health Information Management, or related field.

Responsibilities

• Leads daily activities of the Clinical Denials QA team.
• Assigns and prioritizes QA audits based on workload, risk, denial type, financial impact, and business requirements.
• Monitors QA productivity, audit completion, accuracy, turnaround time, and quality performance.
• Provides coaching, mentoring, and performance feedback to QA staff.
• Supports onboarding, training, and competency development of QA team members.
• Ensures appropriate coverage and distribution of QA workload.
• Escalates significant performance, quality, compliance, and operational concerns to management.
• Oversees routine, targeted, and focused audits of clinical denial reviews and appeals.
• Conducts complex and high-dollar case audits.
• Reviews escalated or disputed QA findings.
• Ensures audit findings are supported by objective evidence.
• Validates consistent application of QA scorecards and error definitions.
• Monitors adherence to client-specific quality requirements.
• Ensures critical quality and compliance issues are appropriately escalated.
• Reviews trends in clinical, coding, documentation, reimbursement, and appeal quality.
• Maintains and updates QA scorecards, audit tools, and quality standards.
• Leads regular calibration sessions for QA staff and operational teams.
• Establishes consistent interpretation of clinical, coding, payer, and quality requirements.
• Identifies areas of disagreement between QA and operations and facilitates resolution.
• Partners with management to establish quality targets and performance expectations.
• Supports development of standardized QA methodologies across clients and programs.
• Analyzes individual, team, client, payer, and denial-category quality trends.
• Prepares QA dashboards and management reports.
• Identifies recurring error patterns and systemic quality risks.
• Tracks critical error trends and corrective action effectiveness.
• Provides insights into the relationship between quality performance and denial recovery.
• Presents quality findings and recommendations to operational leadership.
• Supports client reporting and business reviews as required.
• Partners with Team Leads and Managers to address quality performance issues.
• Provides actionable feedback based on audit findings.
• Identifies training and competency gaps.
• Develops recommendations for targeted training and remediation.
• Monitors effectiveness of corrective actions.
• Supports performance improvement plans where appropriate.
• Ensures feedback is timely, objective, consistent, and documented.
• Identifies systemic issues contributing to inaccurate or unsuccessful appeals.
• Partners with Clinical Denials, CDI, HIM, Coding, Utilization Management, and RCM leadership to address root causes.
• Recommends workflow, training, documentation, and process improvements.
• Participates in denial prevention initiatives.
• Identifies opportunities to improve appeal quality and denial recovery.
• Supports implementation of standardized best practices across teams and clients.
• Maintains knowledge of payer policies, reimbursement guidelines, coding principles, clinical documentation requirements, and applicable regulations.
• Ensures QA standards remain aligned with current requirements.
• Identifies potential compliance risks and escalates appropriately.
• Supports internal and client audits as required.
• Maintains confidentiality of patient and client information.
• Partners with Clinical Denials Team Leads and Managers to improve operational quality.
• Participates in client meetings and quality reviews when required.
• Communicates quality trends, risks, and recommendations clearly and professionally.
• Supports client-specific audit requirements.
• Serves as an escalation point for complex or disputed QA findings.

Skills

Leadership

QA management

Auditing

Clinical denials

Coaching

Problem solving

Attention to detail

Education

Bachelor's degree in Nursing/Healthcare

Tools

Epic

EHR systems

Payer portals

Reporting tools

Job description

TASQ Staffing Solutions is seeking a QA Team Lead – Clinical Denials to lead the QA function for Clinical Denials operations. You will oversee audits, coaching, and calibration to ensure quality standards and client-specific requirements are met.

The role requires strong leadership, 4–5 years in healthcare denials or related fields, and experience in QA or supervisory roles. Onsite work with potential relocation within the region.