Utilization & Denials Audit Lead (Onsite Night)

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

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.