Utilization and Denials Management Auditor

Huron; Taguig; Hybrid; PHP 420,000 - 780,000; Full time

Benefits offered by this job

Healthcare coverage on day one for you

Paid time-off with cash conversion

Group life insurance

Performance bonuses

Job summary

MicroSourcing seeks an experienced Utilization and Denials Management Auditor to oversee day-to-day QA functions for a team of specialists, ensuring client accuracy and performance targets are met.

You will monitor staff performance, support QA program development, and coach team members to elevate denials auditing and utilization management processes. The role requires healthcare QA experience and EMR familiarity.

Qualifications

• QA experience: at least 1 year in utilization management and/or clinical appeals QA or auditing in a healthcare setting.
• Clinical Experience: 3–5 years acute care hospital experience (Med/Surg preferred) or 2–3 years ICU experience
• Education & License: Bachelor of Science in Nursing with active PHRN or USRN license
• RCM Knowledge: Strong understanding of InterQual or MCG clinical guidelines and US insurance and government healthcare programs
• Systems: Experience with EMRs such as Epic, Cerner, or Meditech
• Communication: Excellent English communication skills (CEFR B2)

Responsibilities

• Monitor staff performance using key metrics such as productivity and accuracy for Clinical Denials and Appeals
• Support the development and maintenance of the QA program, including audit design and automation improvements
• Provide coaching, training, and ongoing feedback to improve team performance
• Review production and quality reports, conduct performance evaluations, and facilitate monthly team meetings
• Maintain QA records, audit findings, and support special projects including full utilization and denials audits
• Partner with global Operations, Training, and HR teams to improve onboarding and processes
• Participate in client calibration sessions to align KPIs and expectations
• Support internal audits and client visits by presenting dashboards, reports, and achievements

Skills

QA Experience

Clinical Experience

Communication

Analytical thinking

Education

BSN with active PHRN/USRN license

Tools

Epic

Cerner

Meditech

Microsoft Office

Job description

Discover your 100% YOU with MicroSourcing!

Position: Utilization and Denials Management Auditor
Location: BGC, Taguig City
Work setup & shift:Onsite, Night shift

Why join MicroSourcing?

Competitive Rewards

Enjoy above-market compensation, healthcare coverage on day one for you and your dependents, paid time-off with cash conversion, group life insurance, and performance bonuses.

A Collaborative Spirit

Be part of a positive and engaging work environment through company-sponsored events and activities.

Work-Life Harmony

Experience a balance that suits your lifestyle with flexible work arrangements.

Career Growth

Access opportunities for continuous learning and professional advancement.

Inclusive Teamwork

Join a diverse and inclusive workplace that values every individual's contribution.

Your Role

As a Utilization and Denials Management Auditor, you will oversee the day-to-day production and quality functions of a team of specialists to ensure client accuracy and performance goals are met.

You will:

• Monitor staff performance using key metrics such as productivity and accuracy for Clinical Denials and Appeals
• Support the development and maintenance of the QA program, including audit design and automation improvements
• Provide coaching, training, and ongoing feedback to improve team performance
• Review production and quality reports, conduct performance evaluations, and facilitate monthly team meetings
• Maintain QA records, audit findings, and support special projects including full utilization and denials audits
• Partner with global Operations, Training, and HR teams to improve onboarding and processes
• Participate in client calibration sessions to align KPIs and expectations
• Support internal audits and client visits by presenting dashboards, reports, and achievements

What You Need

Non-negotiables:

• QA Experience: At least 1 year of utilization management and/or clinical appeals QA or auditing experience in a healthcare setting
• Clinical Experience: 3–5 years acute care hospital experience (Med/Surg preferred) or 2–3 years ICU experience
• Education & License: Bachelor of Science in Nursing with active PHRN or USRN license
• RCM Knowledge: Strong understanding of InterQual or MCG clinical guidelines and US insurance and government healthcare programs
• Systems: Experience with EMRs such as Epic, Cerner, or Meditech
• Communication: Excellent English communication skills (minimum CEFR B2)

Preferred Skills

• Advanced Education: Master's degree or related postgraduate qualification in healthcare or business
• Certification: Case management, clinical appeals, or denials certification (e.g., ACMA)
• Tools: Proficiency in Microsoft Office and tracking systems for authorizations or denials
• Soft Skills: Strong analytical thinking, independent judgment, and presentation skills

About MicroSourcing

With over 9,000 professionals across 13 delivery centers, MicroSourcing is the Philippines' pioneer and largest offshore provider of managed services.

We believe our strength lies in our people. Our commitment to 100% YOU means fostering a culture that values diversity, inclusion, and authenticity. Here, individuality is celebrated, and growth is supported.

Join us in celebrating YOU and your 100%.

For more information, visit https://www.microsourcing.com/
Terms & conditions apply