Clinical Appeals Operations Manager

Discover your 100% YOU with MicroSourcing!

Position: Clinical Appeals Operations Manager

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 (for you and at least one dependent), 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 balance between work and life with flexible arrangements that suit you.
• 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 Clinical Appeals Operations Manager, you will:

• Oversee daily Clinical Denials and Appeals operations to ensure timely and accurate processing of denied claims.
• Set 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 of 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.

Our commitment to 100% YOU

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.

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%!

For more information, visit https://www.microsourcing.com/

Terms & conditions apply.