Clinical Denials
4 days ago
Clinical Denials & Appeals QA Specialist Location: Taguig, Philippines. Work setup: Onsite, Night shift. Responsibilities Support the QA program build by identifying key audit areas, critical workflow aspects, and automation opportunities to enhance efficiency. Monitor performance metrics, including productivity and accuracy, for all Clinical Denials & Appeals staff. Escalate production or QA concerns to management and collaborate with Training teams to ensure progress and consistency. Demonstrate strong knowledge of production workflows, quality processes, and documentation standards in medical diagnoses and treatment practices. Conduct QA audits, maintain detailed QA records, and provide constructive feedback to team members. Mentor staff to improve performance, engagement, and job satisfaction. Review reports on production and accuracy, offering actionable insights and coaching for continuous improvement. Collaborate with Operations, Training, and HR to align onboarding, performance metrics, and training outcomes. Participate in client calibration calls, internal audits, and process reviews, representing QA achievements and performance trends. Qualifications (Non-negotiables) At least 1 year of experience in QA or auditing for clinical appeals writing within a BPO or healthcare setting. 3‑5 years of acute care clinical experience in a hospital setting (Med/Surg or similar preferred; 2‑3 years if ICU experience). Bachelor of Science in Nursing. Registered Nurse (PHRN or USRN) with an active license. Proficiency with InterQual or MCG clinical guidelines. Broad knowledge of U.S. Government Programs and Insurance Regulations. Experience with electronic medical records (EMR) 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 tools for tracking denials and appeals. Advanced Microsoft Office Suite skills (Excel, Word, PowerPoint, Outlook, SharePoint). Strong analytical, critical thinking, and communication skills. Excellent attention to detail, independence in decision‑making, and ability to coach and mentor others. Experience working in a matrixed environment and presenting QA insights to clients and stakeholders. About MicroSourcing With over 9,000 professionals across 13 delivery centers, MicroSourcing is a pioneer and leading offshore provider of managed services in the Philippines. The company is committed to fostering an inclusive culture that values diversity and equitable opportunities for all employees. #J-18808-Ljbffr
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Clinical Denials
4 days ago
Taguig, Philippines MicroSourcing Full timeJoin to apply for the Clinical Denials & Appeals Manager role at MicroSourcing Discover your 100% YOU with MicroSourcing! Position: Clinical Denials & Appeals Manager Location: Taguig Work setup & shift: Onsite | Night shift Why join MicroSourcing Competitive Rewards: Enjoy above-market compensation, healthcare coverage on day one (for you and at least one...
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Clinical Denials
4 days ago
Taguig, Philippines MicroSourcing Full timeClinical Denials & Appeals Trainer Join MicroSourcing as a Clinical Denials & Appeals Trainer to provide end‑to‑end training for clinical denials and appeals processes within a BPO environment. You will facilitate training for new hires, cross‑train existing staff, and customize modules to client SLAs, payer guidelines, and EMR platforms. Location &...
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Clinical Denials
4 days ago
Taguig, Philippines MicroSourcing International, Inc. Full timeStart your adventure in the wonderful world of MicroSourcing by signing up now. Clinical Denials & Appeals QA Specialist Call Centre & Customer Service Customer Service BGC, Taguig Permanent / Full Time Position: Clinical Denials & Appeals QA Specialist Location: Taguig Work setup & shift: Onsite | Night shift Why join MicroSourcing? Competitive Rewards:...
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Clinical Denials
4 days ago
Taguig, Philippines MicroSourcing Full timeClinical Denials & Appeals Nurse Specialist - IP & OP Join to apply for the Clinical Denials & Appeals Nurse Specialist - IP & OP role at MicroSourcing Position: Clinical Denials & Appeals Nurse Specialist - IP & OPLocation: TaguigWork setup & shift: Onsite | Night shift Why join MicroSourcing? Competitive Rewards: Enjoy above-market compensation, healthcare...
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AR Clinical Denials Director
2 days ago
Taguig, National Capital Region, Philippines ADI Group Full time ₱1,200,000 - ₱2,400,000 per yearPosition Summary - Responsible for Client operations including the execution of Clinical Denials. Also has overall responsibility for delivering on respective process metrics such as account cycle time and functions thereof, process cost and functions thereof, adherence to process standards, and process quality. This involves conducting continuous...
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PHRN – Clinical Authorization
3 weeks ago
Taguig, Philippines Go-Get Data Consultancy Full timeOverview Job title: PHRN – Clinical Authorization Work set up: Onsite Opportunity – MCK Taguig, Cyber Sigma Building Work schedule: Weekdays Night Shift schedule, Fixed Weekends Off Salary: 45K to 50K package if licensed PHRN, salary for approval if non-licensed Responsibilities Contact insurance carriers to verify patient’s insurance eligibility,...
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Clinical Services Manager | ASAP
2 weeks ago
Taguig, Philippines HRTX Full timeQualifications Minimum of 5+ years of combined experience in direct patient care and/or a clinical administrator role (e.g., utilization management, clinical authorizations, clinical denials, or clinical documentation integrity) with a solid track record in reputable organizations. Registered Nurse (RN) or hold another clinical patient care designation....
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Taguig, Philippines MicroSourcing Full timeClinical Documentation Improvement Nurse Specialist – IP Location: TaguigWork setup & shift: Onsite | Night shiftCompany: MicroSourcing Benefits Competitive rewards with above‑market compensation, healthcare coverage on day one (for you and at least one dependent), paid time‑off with cash conversion, group life insurance, and performance bonuses....
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Taguig, Philippines HRTX Full timeWe're Hiring: PHRN Quality Auditor Clinical Services Location: Onsite, Mckinley, Taguig Schedule: Night Shift | Monday to Friday Hiring Target Date: Preferably by July 21, 2025 Salary Range: Up to 50k Qualifications Must hold an active PHRN license (Not a USRN holder) Prior experience as a Quality Auditor in a healthcare BPO clinical setting Alternatively, 4...
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Clinical Services Manager
2 days ago
Taguig, National Capital Region, Philippines HRTX Full time $100,000 - $120,000 per yearQualifications:Experience & EducationMinimum of 5+ years of combined experience in direct patient care and/or a clinical administrator role (e.g., utilization management, clinical authorizations, clinical denials, or clinical documentation integrity) with a solid track record in reputable organizations.Registered Nurse (RN) or hold another clinical patient...
