Utilization & Denials Auditor — QA & Training Lead

MicroSourcing; Philippines; On-site; PHP 502,000 - 837,000; Full time

Benefits offered by this job

Above-market compensation

Healthcare coverage day one

Dependent coverage

Paid time-off with cash conversion

Group life insurance

Performance bonuses

Job summary

MicroSourcing is hiring for a Utilization and Denials Management Auditor in Taguig, Philippines. This role supports the day-to-day QA and production activities of the Utilization and Denials Management team to help meet client productivity and accuracy goals.

The ideal candidate has 1 year of QA/auditing experience in healthcare, a BSN, and an active RN license (PHRN/USRN), with strong knowledge of InterQual/MCG guidelines and EMR systems.

Qualifications

• At least 1 year of Utilization Management and/or Clinical Appeals QA/auditing in healthcare.
• Minimum 3–5 years acute care clinical experience; 2–3 years ICU preferred.
• BSN degree and RN license (PHRN/USRN).
• Proficiency with InterQual/MCG guidelines and hospital EMR systems.

Responsibilities

• Support day-to-day production and QA for Utilization and Denials Management teams.
• Assist QA program build by auditing critical workflows and defining audit attributes.
• Monitor staff performance using key productivity and accuracy metrics.
• Escalate QA/production issues to Manager; coordinate with Training on progress.
• Provide training, coaching, and feedback; maintain QA records and audit results.

Skills

Utilization Management

Clinical Appeals

Auditing

BSN

PHRN/USRN license

InterQual/MCG guidelines

Epic/Cerner/Meditech

English communication

MS Office (Excel/PowerPoint)

Teamwork

Education

BSN

Tools

Epic

Cerner

Meditech

SharePoint

MS Office

Job description

MicroSourcing is hiring for a Utilization and Denials Management Auditor in Taguig, Philippines. This role supports the day-to-day QA and production activities of the Utilization and Denials Management team to help meet client productivity and accuracy goals.

The ideal candidate has 1 year of QA/auditing experience in healthcare, a BSN, and an active RN license (PHRN/USRN), with strong knowledge of InterQual/MCG guidelines and EMR systems.