QA Clinical Denials Auditor – Night Shift (Onsite)

TASQ Staffing Solutions; Taguig; On-site; PHP 446,000 - 781,000; Full time

Job summary

TASQ Staffing Solutions in Taguig is seeking a QA – Clinical Denials specialist to perform quality audits of denial reviews, support appeal preparation, and ensure documentation accuracy across payer requirements.

You will collaborate with Clinical Denials Specialists, Team Leads, CDI, HIM, Coding, and other revenue cycle stakeholders to improve appeal quality, reduce errors, and strengthen denial recovery outcomes.

Qualifications

• Bachelor's degree in a healthcare field and active RN license or equivalent credential.
• 2–3 years in clinical denials, CDI, utilization management, coding, or related areas.
• Experience reviewing medical records and clinical documentation.
• Strong knowledge of medical terminology, documentation, coding, reimbursement, and payer requirements.
• Excellent written and verbal communication with strong attention to detail.

Responsibilities

• Conduct routine and targeted quality audits of clinical denial reviews and appeals.
• Review denied claims, medical records, billing information, payer correspondence, and appeal documentation.
• Evaluate accuracy of denial identification, clinical analysis, coding validation, and appeal rationale.
• Validate that appeal arguments are supported by records and guidelines.
• Review denial cases for medical necessity, clinical validation, DRG, level-of-care, and coding.
• Identify quality errors and ensure appeals are complete and timely.
• Apply QA scorecards and report findings objectively; maintain audit records.
• Provide feedback to clinicians and partners; support coaching and remediation.
• Suggest process improvements and participate in denial prevention initiatives.

Skills

Analytical skills

Problem-solving

Written and verbal communication

Attention to detail

Independent work

Medical terminology knowledge

Clinical documentation understanding

Coding principles knowledge

Reimbursement knowledge

Payer requirements knowledge

Education

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

RN license or applicable clinical credential

Tools

Epic EHR

Payer denial portals

QA scorecards

Audit tools

Reporting dashboards

Job description

TASQ Staffing Solutions in Taguig is seeking a QA – Clinical Denials specialist to perform quality audits of denial reviews, support appeal preparation, and ensure documentation accuracy across payer requirements.

You will collaborate with Clinical Denials Specialists, Team Leads, CDI, HIM, Coding, and other revenue cycle stakeholders to improve appeal quality, reduce errors, and strengthen denial recovery outcomes.