Night Shift QA Auditor: Utilization & Denials

MicroSourcing International

Taguig

On-site

PHP 600,000 - 900,000

Full time

14 days+

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Benefits offered by this job

Healthcare coverage from day one

Dependent coverage

Paid time off with cash conversion

Group life insurance

Performance bonuses

Job summary

MicroSourcing International in Taguig City (BGC) seeks a Utilization and Denials Management Auditor for onsite night shift. You will support daily production and QA, assist in audit development, monitor staff performance, and escalate blockers while liaising with Training and HR to optimize onboarding and training dashboards.

The role requires BSN and active RN license (PHRN/USRN), plus 1+ year in Utilization Management/Clinical Appeals QA.

Qualifications

At least 1 year of Utilization Management and/or Clinical Appeals Writing QA or auditing experience in a healthcare setting.
Minimum 3–5 years of acute care clinical experience in a hospital setting, with Med/Surg or similar preferred; 2–3 years if ICU experience.
Bachelor of Science in Nursing (BSN).
Must be a Registered Nurse with an active PHRN or USRN license.
Proficiency in using InterQual or MCG clinical guidelines.
Broad knowledge of U.S. Government Programs and Insurance Regulations.
Proficiency with hospital-based EMR such as Epic, Cerner, or Meditech.
Excellent verbal and written English communication and customer service skills, with a CEFR level of at least B2 for both verbal and written communication.

Responsibilities

Support the day-to-day production and quality functions of Utilization and Denials Management specialists to help meet client productivity and accuracy goals.
Assist in QA program build, including identifying critical workflow areas to audit, defining effective audit attributes, and leveraging automation and efficiency tools.
Monitor Utilization and Denials Management staff using key metrics, including Utilization Management and Clinical Denials & Appeals productivity and accuracy.
Escalate production and QA concerns or roadblocks to the Manager and work with Training teams to communicate progress.
Apply domain expertise in quality processes related to production schedules and documentation of medical diagnoses and treatment practices.
Maintain a strong understanding of Utilization and Denials Management production and quality assurance processes and guidelines.
Provide training, coaching, mentoring, and regular feedback to team members.
Monitor and maintain team QA records, auditing results, and education findings.
Complete full Utilization and Denials Management audits and other special projects as assigned.
Review production, quality, accuracy, and system reports and share feedback on progress.
Partner with global Operations, Training, and HR to streamline onboarding and on-the-job learning.
Participate in client calibration calls to align training KPIs with operational metrics.
Support client visits, internal audits, and process reviews by presenting training dashboards and achievements.
Perform other duties and responsibilities as assigned.