Denials Management Manager

MicroSourcing is seeking a dedicated Denials Management Manager to lead Clinical Denials and Appeals operations in Taguig. Location Taguig, Philippines Work Setup & Shift Onsite | Night shift> Why Join MicroSourcing Competitive Rewards: Above‑market compensation, immediate healthcare coverage, paid time‑off with cash conversion, group life insurance, and performance bonuses. A Collaborative Spirit: Contribute to a positive work environment through company‑sponsored events. Work‑Life Harmony: Flexible arrangements to balance professional and personal responsibilities. Career Growth: Continuous learning and advancement opportunities. Inclusive Teamwork: A culture that celebrates diversity and inclusion. Your Role Oversee daily Clinical Denials and Appeals operations to ensure timely and accurate processing of denied claims. objectives, assign tasks, and monitor performance to meet operational goals. Ensure compliance with regulatory guidelines, payer requirements, and internal policies. Partner with Billing, A/R, HIM, Revenue Integrity, and Coding teams to address root causes of denials and support accurate claim generation. Communicate team performance and KPIs during Operations Meetings, highlighting progress and areas for improvement. Provide training and mentorship to Clinical Denials & Appeals staff and supervisors to support development and succession planning. Stay updated with Clinical Denials & Appeals guidelines and ensure policies and procedures reflect best practices. Collaborate with IT for system and tool optimization, including EHR and Clinical Denials & Appeals systems. Work closely with physicians, nurses, and healthcare professionals to ensure proper documentation of patient care. Perform other related duties as assigned. What You Need – Non‑Negotiables Bachelor of Science in Nursing Active PHRN or USRN license Minimum 2 years in Clinical Denials and Appeals management 3–5 years of acute care clinical experience in a hospital setting (2–3 years if ICU experience) Proficiency in InterQual or MCG clinical guidelines Broad knowledge of U.S. Government Programs and Insurance Regulations Experience with EMR systems such as Epic, Cerner, or Meditech Preferred Skills / Expertise Master's degree or credential in business, healthcare, or related field Certification in case management, clinical appeals, or clinical denials Proficiency with denial and appeals tracking systems and Microsoft Office Suite (Excel, Word, PowerPoint, Outlook, SharePoint) Proven leadership, mentoring, and performance management experience Strong analytical, communication, and critical thinking skills Ability to make independent decisions and manage multiple priorities in a matrixed environment Excellent attention to detail, follow‑through, and stakeholder management skills About MicroSourcing With over 9,000 professionals across 13 delivery centers, MicroSourcing is the pioneer and largest offshore provider of managed services in the Philippines. MicroSourcing firmly believes that our company's strength lies in our people's diversity and talent. We are proud to foster an inclusive culture that embraces individuals of all races, genders, ethnicities, abilities, and backgrounds. We provide space for everyone—embracing different perspectives and making room for opportunities for each individual to thrive. Our Commitment to 100 % YOU Equity, inclusion, and authenticity are at the core of MicroSourcing. We celebrate your unique, authentic self and value every individual's contribution to our collective success and growth. For more information, visit Terms & conditions apply. #J-18808-Ljbffr