Job Description
USRN Quality Assurance Specialist
On-site | Bridgetowne, Quezon City
Night Shift
Start Date: December 31, 2025 / ASAP
Salary Range: 60,000 90,000
About the Role
We are seeking a highly skilled USRN Quality Assurance Specialist to support the accuracy, compliance, and performance standards of our Medicare Part C Appeals operations. This role ensures alignment with CMS regulatory requirements while providing coaching and quality insights that elevate team performance.
Qualifications
Education & Licensure
Bachelor's Degree in Nursing
Active and valid USRN license (Massachusetts)
Experience
Minimum 1 year experience in Appeals & Grievances (Medicare Part C Appeals focus)
12 years experience as a Quality Assurance Specialist/Evaluator in a clinical BPO or CPO setting
1 year InterQual experience (Medicare & Medicaid)
Experience supporting CMS Program Audits and Client Audits
Prior experience mentoring and coaching new QA staff
Technical & Regulatory Knowledge
Strong understanding of CMS Medicare Part C Appeals regulatory standards
In depth knowledge of clinical terminology, medical necessity review principles, and health insurance operations
Proficiency with Quality Audit Systems and Microsoft Office Suite
High attention to detail with excellent documentation, writing, and scoring calibration skills
Soft Skills
Excellent verbal and written communication skills
Strong analytical, critical thinking, and problem solving abilities
Collaborative mindset with effective coaching and communication abilities
Other Requirements
Willing to work onsite with flexible schedules, including US hours and holidays
