Utilization and Denials Management Auditor

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