Deskripsi Pekerjaan
Join MicroSourcing as a Utilization and Denials Management Auditor and celebrate your 100% impact in a hybrid role offering perfect work-life balance. We're seeking a meticulous professional to drive excellence in our financial operations, ensuring compliance and optimizing resource utilization through rigorous audits. This position combines the flexibility of remote work with collaborative on-site collaboration in our Quezon City office. You'll be instrumental in identifying process inefficiencies, reducing claim denials, and implementing evidence-based improvements that directly impact our bottom line. At MicroSourcing, your analytical expertise is valued, and your contributions are recognized through continuous learning opportunities and career advancement paths. If you're passionate about financial integrity and want to make a measurable difference in a supportive environment, this is your opportunity to thrive.
Tanggung Jawab
- Conduct comprehensive audits of utilization and denials management processes to ensure regulatory compliance
- Analyze claim data patterns to identify root causes of denials and recommend corrective actions
- Collaborate with healthcare providers and internal teams to resolve discrepancies in billing documentation
- Develop and implement audit protocols aligned with industry standards and company policies
- Prepare detailed audit reports with actionable insights for stakeholders
- Monitor compliance with HIPAA, PHI, and other healthcare regulations
- Identify opportunities for process optimization and cost reduction
Kualifikasi
- Bachelor's degree in Accounting, Finance, Healthcare Administration, or related field
- Minimum 3 years of experience in utilization review or denials management auditing
- Proficiency in auditing software (e.g., ACL, Tableau) and healthcare billing systems
- Certified Healthcare Auditor (CHA) or Certified Internal Auditor (CIA) preferred
- Advanced knowledge of healthcare billing regulations and claim submission guidelines
- Exceptional analytical skills with attention to detail and accuracy
- Strong written and verbal communication skills for stakeholder reporting
- Ability to manage multiple projects with competing deadlines