Team Leader - Clinical Denials

TASQ; Pateros; On-site; PHP 650,000 - 900,000; Full time

Job summary

TASQ seeks a Team Lead – Clinical Denials to guide a team of Clinical Denials Specialists supporting U.S. healthcare clients. You will oversee daily workflow, productivity, quality, and escalation handling.

Role requires RN/healthcare background, leadership experience with 20+ staff, and the ability to align with U.S. payer policies and denials management while working U.S.-aligned night shifts onsite at Taguig/ Bridgetowne transfer.

Qualifications

• Bachelor’s degree in nursing or related field.
• Valid Philippine RN license/PRC registration for RN-required positions.
• 3–5 years in U.S. healthcare RCM, clinical denials, CDI, utilization management, claims, or appeals.
• Demonstrated experience leading or mentoring healthcare teams, preferably 20+ employees.
• Strong knowledge of medical necessity, DRG, level of care, coding, reimbursement, and U.S. payer policies.
• Strong communication, analytical, problem-solving, and people-management skills.
• Willingness to work U.S.-aligned shifts as required.

Responsibilities

• Leads daily activities of a team of 20+ Clinical Denials Specialists.
• Assigns and prioritizes denial inventory based on complexity, aging, financial impact, and payer requirements.
• Monitors productivity, quality, turnaround time, and appeal outcomes.
• Provides coaching, mentoring, and performance feedback.
• Supports onboarding and training of team members.
• Escalates operational, clinical, payer, and client issues to management.
• Reviews complex and high-dollar clinical denials.
• Provides guidance on medical necessity, DRG, level of care, clinical validation, documentation, and coding-related denials.
• Reviews appeal letters for accuracy, completeness, and supporting evidence.
• Supports interpretation of U.S. payer policies and reimbursement requirements.
• Collaborates with CDI, HIM, Coding, Utilization Management, and other RCM stakeholders.
• Partners with QA to address quality findings and performance gaps.
• Identifies recurring denial trends and opportunities for prevention.
• Supports root-cause analysis and process improvement initiatives.
• Ensures work complies with client requirements, payer policies, privacy, and organizational standards.
• Reviews team performance reports and KPIs.
• Communicates trends, risks, and action plans to management.
• Supports client and internal meetings as required.

Skills

Team leadership

Mentoring/coaching

Communication

Problem solving

People management

Education

Bachelor's degree in nursing/healthcare

Tools

Epic

U.S. payer portals

Job description

Work setup: ONSITE / BGC, Taguig within 6 months then transfer to Bridgetowne, QC

Work schedule: Nightshift

The Team Lead – Clinical Denials provides operational and clinical leadership to a team of Clinical Denials Specialists supporting U.S. healthcare clients. The role oversees daily workflow, productivity, quality, employee performance, complex denial escalations, and denial prevention activities.

The Team Lead serves as a subject-matter resource for medical necessity, clinical documentation, DRG, level of care, coding, reimbursement, and U.S. payer requirements.

Qualifications:

Required

• Bachelor’s degree in nursing, Healthcare Administration, Health Information Management, or related field.
• Valid Philippine RN license/PRC registration for RN-required positions.
• 3 to 5 years of experience in U.S. healthcare RCM, clinical denials, CDI, utilization management, claims, or appeals.
• Demonstrated experience leading or mentoring healthcare teams, preferably 20+ employees.
• Strong knowledge of medical necessity, DRG, level of care, clinical documentation, coding, reimbursement, and U.S. payer policies.
• Strong communication, analytical, problem-solving, and people-management skills.
• Willingness to work U.S.-aligned shifts as required.

Preferred

• CDAS or equivalent denial management credential.
• CCDS/CDIP or equivalent CDI certification.
• CCS/CPC or equivalent coding certification.
• Experience with Epic and U.S. payer portals.
• Experience managing denial inventory and performance dashboards.

Duties and Responsibilities

Team Leadership & Operations

• Leads daily activities of a team of 20+ Clinical Denials Specialists.
• Assigns and prioritizes denial inventory based on complexity, aging, financial impact, and payer requirements.
• Monitors productivity, quality, turnaround time, and appeal outcomes.
• Provides coaching, mentoring, and performance feedback.
• Supports onboarding and training of team members.
• Escalates operational, clinical, payer, and client issues to management.

Denial Review & Appeals

• Reviews complex and high-dollar clinical denials.
• Provides guidance on medical necessity, DRG, level of care, clinical validation, documentation, and coding-related denials.
• Reviews appeal letters for accuracy, completeness, and supporting evidence.
• Supports interpretation of U.S. payer policies and reimbursement requirements.
• Collaborates with CDI, HIM, Coding, Utilization Management, and other RCM stakeholders.

Quality & Denial Prevention

• Partners with QA to address quality findings and performance gaps.
• Identifies recurring denial trends and opportunities for prevention.
• Supports root-cause analysis and process improvement initiatives.
• Ensures work complies with client requirements, payer policies, privacy, and organizational standards.

Reporting & Stakeholder Management

• Reviews team performance reports and KPIs.
• Communicates trends, risks, and action plans to management.
• Supports client and internal meetings as required.
• Maintains effective communication with U.S.-based stakeholders.