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MicroSourcing

Utilization & Denials Management Manager

MicroSourcing
Taguig, Philippines
2-5 Years
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Job Description

Discover your 100% YOU with MicroSourcing!

Position: Utilization & Denials Management 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, plus one or more dependents, 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.
Your Role
As a Utilization & Denials Management Manager, you will:
Operational Oversight
  • Manage a team to achieve goals by overseeing daily activities, assigning tasks, and providing guidance and motivation.
  • Set objectives, monitor performance, solve problems, and facilitate communication between the team and upper management.
  • Provide strong leadership, communication, and problem-solving support to ensure operational efficiency.
Quality & Compliance
  • Address Utilization Management and Clinical Denials, partnering with Billing and A/R teams to identify root causes.
  • Stay current on Utilization Management and Clinical Denials updates and disseminate guidance to staff.
  • Ensure policies and procedures reflect current compliant practices for medical coding and denials/appeals management.
Collaboration & Support
  • Communicate team performance in Operations Meetings, including reporting KPIs, progress, and opportunities.
  • Collaborate with HIM, Revenue Integrity, Coding, Billing, and Clinical departments to ensure clean claim generation.
  • Support coding accuracy through collaboration with revenue integrity teams.
  • Coordinate with IT for optimization of encoder, EHR, Utilization Management, and Clinical Denials & Appeals systems.
Education & Training
  • Provide guidance on education strategies for Utilization Management and Clinical Denials & Appeals, including updates on clinical denials, documentation changes, and audit findings.
  • Mentor supervisors, trainers/QA specialists, and RN specialists to support succession planning and career development.
Coordinating with Healthcare Providers
  • Work closely with physicians, nurses, and other healthcare professionals to ensure timely and accurate documentation reflecting patient care.
  • Perform other duties and responsibilities as assigned.
What You NeedNon-negotiables
  • At least 2 years of experience managing Utilization Management and/or Clinical Denials & Appeals teams.
  • 3-5 years of acute care clinical experience in a hospital setting (Med/Surg or similar

More Info

Job Type:
Permanent Job
Industry:
IT/Computers - Software
Function:
Healthcare
Employment Type:
Full time

About Company

MicroSourcing

Founded in 2006, we pioneered a new way of offshoring. This model involves setting up an overseas division of your company and getting a local specialist to handle facilities, IT, labor laws, recruitment and HR, while you retain control over quality and productivity. Today, we&#8217&#x3B;re still one of the largest and most experienced offshoring providers in the Philippines, with 400+ active clients and 6,000+ employees. We operate within purpose-built, class-A facilities that are strategically located for access to Manila&#8217&#x3B;s most talented people. We&#8217&#x3B;re backed by our Australian parent company, Probe and we&#8217&#x3B;re ISO certified.

Job ID: 136336355

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Last Updated: 19-12-2025 08:42:50 AM
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