Denials & Appeals Compliance Specialist
MicroSourcing
Date: 5 hours ago
City: Taguig
Contract type: Full time
Discover your 100% YOU with MicroSourcing!
Position: Denials & Appeals Compliance Specialist
Location: Taguig
Work setup & shift: Onsite | Night shift
Why join MicroSourcing?
You'll Have
As a Denials & Appeals Compliance Specialist, You Will
Non-negotiables
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.
Position: Denials & Appeals Compliance Specialist
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 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.
As a Denials & Appeals Compliance Specialist, You Will
- 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.
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 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.
- 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.
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.
How to apply
To apply for this job you need to authorize on our website. If you don't have an account yet, please register.
Post a resumeSimilar jobs
Territory Delivery Senior Expert
Globe Telecom,
Taguig
7 hours ago
At Globe, our goal is to create a wonderful world for our people, business, and nation. By uniting people of passion who believe they can make a difference, we are confident that we can achieve this goal.Job DescriptionThe Territory Delivery Lead acts as the overall Access Delivery Project Manager for the assigned Territory or National, overseeing the end-to-end build process....
Associate Strategy And Insights Manager Large Customer Sales
TALENTMATE,
Taguig
1 day ago
Job DescriptionIf you are a foreign national finalist for a role in the Philippines and require a work permit, please be aware that Philippine labor law mandates the publication of your name and nationality in a national newspaper and the designated local government portal, as part of the immigration compliance process. This is a required step for completing your job...
Medical Representative
AstraZeneca,
Taguig
1 day ago
Do you have expertise in, and passion for, pharmaceutical sales? Would you like to apply your expertise to impact an organization that follows the science and turns ideas into life changing medicines? Then AstraZeneca might be the one for you!About AstrazenecaAstraZeneca is a global, science-led, patient-focused biopharmaceutical company that focuses on the discovery, development and commercialization of prescription medicines for...
