USRN Quality Assurance Specialist

4 days ago

Quezon City, National Capital Region, Philippines BEWAHARVEST Full time ₱60,000 - ₱90,000 per year

Job Title: USRN Quality Assurance Specialist

Shift: Night shift

Work Set-up: On-site in Bridgetowne, Quezon City

Salary range: 60K to 90K

Start date: Dec 31, 2025/ ASAP

Recruitment Process: 2 Virtual interview processes

QUALIFICATIONS:


• Bachelor's Degree in Nursing with an active and valid license in USRN Massachusetts


• Minimum of 1 year experience in appeals and grievances workstream with focus on Medicare Part C Appeals


•At least 1 year to 2 years experience as a Quality Assurance or Quality Evaluator in a clinical BPO or CPO setting


• In-depth knowledge and understanding of CMS Medicare Part C Appeals regulatory standards


• Strong understanding of clinical terminology, medical necessity review principles and healthcare insurance operations


• Experience supporting external audits (CMS Program Audits) and Client Audits


• Must have an experience in mentoring or coaching new quality staff


• Excellent verbal and written communication skills


• High attention to detail with strong documentation, writing, and scoring calibration skills


• Proficiency in Quality Audit Systems and Microsoft Office Suite


• Strong analytical, critical thinking and problem solving skills


• Excellent communication, coaching, and collaboration abilities


• InterQual experience of at least 1 year (Medicare and Medicaid)


• Willingness to work on-site with flexible schedules, including US hours and holidays


• Must not be a current or former employee of Concentrix

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