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Utilization & Denials Management Supervisor

3 hours ago

Taguig, National Capital Region, Philippines MicroSourcing Full time

Discover your 100% YOU with MicroSourcing
Position:
Utilization & Denials Management Supervisor

Location:
Taguig

Work setup & shift:
Onsite | Night shift

Why join MicroSourcing?
You'll Have

  • Competitive Rewards: Enjoy above-market compensation, healthcare coverage on day one, plus one or more dependents, paid time-off with cash conversion, group life insurance, and performance bonuses
  • A Collaborative Spirit: Contribute to a positive and engaging work environment by participating in company-sponsored events and activities.
  • Work-Life Harmony: Enjoy the balance between work and life that suits you with flexible work arrangements.
  • Career Growth: Take advantage of opportunities for continuous learning and career advancement.
  • Inclusive Teamwork: Be part of a team that celebrates diversity and fosters an inclusive culture.

Your Role
As a Utilization & Denials Management Supervisor, You Will
Operational Oversight

  • Supervise and support Clinical Denials & Appeals staff, including hiring, onboarding, scheduling, and performance management.
  • Monitor productivity, accuracy, and operational metrics of the team.
  • Ensure timely resolution of clinical denials and appeals issues.

Quality & Compliance

  • Conduct Utilization Management and Clinical Denials & Appeals audits and accuracy reviews to ensure compliance with payer regulations.
  • Partner with Billing and A/R teams to identify root causes of clinical denials.
  • Stay current with Utilization Management and Clinical Denials updates and disseminate guidance to staff.
  • Ensure policies and procedures reflect current compliant practices for medical coding and denials/appeals.

Collaboration & Support

  • Communicate team performance in Operations Meetings, reporting on KPIs, progress, and opportunities.
  • Collaborate with HIM, Revenue Integrity, Coding, Billing, and Clinical departments to ensure clean claim generation.
  • Support coding accuracy through collaboration with revenue integrity teams.
  • Coordinate with IT for optimization of encoder, EHR, Utilization Management, and Clinical Denials & Appeals systems.

Education & Training

  • Provide ongoing education on clinical denials updates, documentation changes, and audit findings.
  • Mentor Utilization Review/Clinical Denials & Appeals specialists to support career growth and development.

Coordinating with Healthcare Providers

  • Work closely with physicians, nurses, and other healthcare professionals to ensure timely and accurate documentation reflecting patient care.
  • Perform other duties and responsibilities as assigned.

What You Need
Non-negotiables

  • At least 1 year of supervisory experience in Utilization Management and/or Clinical Denials & Appeals.
  • 3–5 years of acute care clinical experience in a hospital setting (Med/Surg or similar); 2–3 years if ICU experience.
  • Bachelor of Science in Nursing.
  • Active Registered Nurse (RN) license with PHRN or USRN credentials.
  • Proficiency in InterQual or MCG clinical guidelines with strong knowledge of U.S. Government Programs and Insurance Regulations.
  • Experience with hospital-based EMR systems such as Epic, Cerner, or Meditech.
  • Strong verbal and written English communication skills (CEFR B2 minimum) and customer service skills.

Preferred skills/expertise

  • Master's degree or credential in business, healthcare, or related field preferred.
  • Certification in case management, clinical appeals, or clinical denials (ACMA preferred).
  • Proficiency in tracking tools for authorizations, denials, and appeals, as well as Microsoft Office Suite (Excel, Word, PowerPoint, Outlook, SharePoint).
  • Proven leadership experience managing teams, including coaching, mentoring, and performance management.
  • Ability to independently lead teams, set project direction, develop deliverables, escalate risks, and influence stakeholders.
  • Strong analytical and critical thinking skills with experience in a matrixed environment.
  • Attention to detail with strong follow-up and follow-through skills.
  • Demonstrated teamwork, integrity, and professionalism in all work-related activities.
  • Excellent written and verbal communication skills, including ability to create impactful presentations.
  • Comfortable making complex decisions independently using sound judgment and discretion.

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.

Our commitment to 100% YOU
MicroSourcing firmly believes that our company's strength lies in our people's diversity and talent. We foster an inclusive culture that embraces individuals of all races, genders, ethnicities, abilities, and backgrounds.

At MicroSourcing, equality is not merely a slogan – it's our commitment. Our way of life. Here, we don't just accept your unique authentic self – we celebrate it, valuing every individual's contribution to our collective success and growth. Join us in celebrating YOU and your 100%

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