QA Lead: Clinical Denials & Audit Quality

Tasq Staffing Solutions, Inc.; Quezon City; On-site; PHP 600,000 - 900,000; Full time

Job summary

Tasq Staffing Solutions, Inc. is seeking a QA – Clinical Denials professional to conduct quality audits of clinical denial reviews, prepare appeals, and validate documentation and coding.

The role ensures accuracy, compliance, and alignment with payer requirements while supporting improvement initiatives. Based in the Philippines with an onsite work setup, the candidate will work night shifts and collaborate with CDI, HIM, Coding, and other revenue cycle stakeholders to reduce errors and

Qualifications

• Bachelor’s degree in a healthcare field and active RN or clinical credential.
• 2–3 years of healthcare experience in clinical denials, CDI, utilization management, coding, RCM, claims or appeals.
• Experience reviewing medical records and clinical documentation.
• Strong knowledge of medical terminology, documentation, coding principles, reimbursement and payer requirements.
• Excellent written and verbal communication and attention to detail.

Responsibilities

• Conducts routine and targeted QA audits of clinical denial reviews and appeals.
• Reviews denied claims, medical records, billing info, payer correspondence, and appeal docs.
• Evaluates accuracy of denial identification, clinical analysis, coding validation and appeal rationale.
• Validates that appeal arguments are supported by records and guidelines.
• Reviews medical necessity, clinical validation, DRG, level-of-care and coding in denial cases.
• Identifies quality errors and ensures audits are complete, timely and well supported.
• Maintains QA records and reports and escalates concerns as needed.

Skills

Analytical skills

Problem solving

Communication

Attention to detail

Documentation review

Education

Bachelor's degree in Nursing

Bachelor's degree in Healthcare Administration

Bachelor's degree in Health Information Management

Tools

Epic

EHR systems

QA scorecards

Job description

Tasq Staffing Solutions, Inc. is seeking a QA – Clinical Denials professional to conduct quality audits of clinical denial reviews, prepare appeals, and validate documentation and coding.

The role ensures accuracy, compliance, and alignment with payer requirements while supporting improvement initiatives. Based in the Philippines with an onsite work setup, the candidate will work night shifts and collaborate with CDI, HIM, Coding, and other revenue cycle stakeholders to reduce errors and