Discover your 100% YOU with MicroSourcing!

Position: Utilization and Denials Management Auditor

Location: BGC, Taguig City

Work setup & shift: Onsite, Night shift

Why join MicroSourcing

Competitive Rewards

Enjoy above-market compensation, healthcare coverage on day one for you and your dependents, paid time-off with cash conversion, group life insurance, and performance bonuses.

A Collaborative Spirit

Be part of a positive and engaging work environment through company-sponsored events and activities.

Work-Life Harmony

Experience a balance that suits your lifestyle with flexible work arrangements.

Career Growth

Access opportunities for continuous learning and professional advancement.

Inclusive Teamwork

Join a diverse and inclusive workplace that values every individual's contribution.

Your Role

As a Utilization and Denials Management Auditor, you will oversee the day-to-day production and quality functions of a team of specialists to ensure client accuracy and performance goals are met.

You Will

Monitor staff performance using key metrics such as productivity and accuracy for Clinical Denials and Appeals
Support the development and maintenance of the QA program, including audit design and automation improvements
Provide coaching, training, and ongoing feedback to improve team performance
Review production and quality reports, conduct performance evaluations, and facilitate monthly team meetings
Maintain QA records, audit findings, and support special projects, including full utilization and denials audits
Partner with global Operations, Training, and HR teams to improve onboarding and processes
Participate in client calibration sessions to align KPIs and expectations
Support internal audits and client visits by presenting dashboards, reports, and achievements

Non-negotiables

What You Need

QA Experience: At least 1 year of utilization management and/or clinical appeals QA or auditing experience in a healthcare setting
Clinical Experience: 3–5 years acute care hospital experience (Med/Surg preferred) or 2–3 years ICU experience
Education & License: Bachelor of Science in Nursing with active PHRN or USRN license
RCM Knowledge: Strong understanding of InterQual or MCG clinical guidelines and US insurance and government healthcare programs
Systems: Experience with EMRs such as Epic, Cerner, or Meditech
Communication: Excellent English communication skills (minimum CEFR B2)

Preferred Skills

Advanced Education: Master's degree or related postgraduate qualification in healthcare or business
Certification: Case management, clinical appeals, or denials certification (e.g., ACMA)
Tools: Proficiency in Microsoft Office and tracking systems for authorizations or denials
Soft Skills: Strong analytical thinking, independent judgment, and presentation skills

About MicroSourcing

With over 9,000 professionals across 13 delivery centers, MicroSourcing is the Philippines pioneer and largest offshore provider of managed services.

We believe our strength lies in our people. Our commitment to 100% YOU means fostering a culture that values diversity, inclusion, and authenticity. Here, individuality is celebrated, and growth is supported.

Join us in celebrating YOU and your 100%.

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

Terms & conditions apply

Utilization and Denials Management Auditor | Onsite, Night shift