Discover your 100% YOU with MicroSourcing!

Position: Clinical Appeals Operations Manager
Location: Taguig
Work setup & shift: Onsite | Night shift

Why join MicroSourcing

Youu0027ll 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

Masteru0027s 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 companyu0027s strength lies in our peopleu0027s 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 - itu0027s our commitment. Our way of life. Here, we donu0027t just accept your unique, authentic self - we celebrate it, valuing every individualu0027s 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.

Registered Nurse (PHRN) - Clinical Appeals Writer | WFH

Clinical Appeals Operations Manager

Clinical Appeals Nurse

Clinical Appeals Consultant - Medical Doctor (Internal Medicine)