Deskripsi Pekerjaan
Are you a healthcare revenue cycle professional looking for your next leadership challenge? MicroSourcing is seeking a highly skilled Utilization & Denials Management Supervisor to join our dynamic team in Quezon City. In this pivotal role, you will be the bridge between clinical documentation and financial reimbursement, ensuring that our operations maintain the highest standards of accuracy and efficiency.
At MicroSourcing, we pride ourselves on celebrating YOU and your 100%. We provide a supportive, hybrid work environment where your expertise in denials management, insurance follow-ups, and clinical review is not only valued but instrumental to our continued success. If you are passionate about reducing claim denials, optimizing revenue cycle workflows, and leading high-performing teams to success, we want to hear from you.
Tanggung Jawab
- Lead and mentor a team of Utilization Review Specialists and Denials Coordinators to ensure optimal departmental performance.
- Oversee the end-to-end management of claim denials, including analysis, root cause identification, and appeal submission.
- Monitor clinical documentation to ensure medical necessity and compliance with payer requirements.
- Conduct regular quality audits and performance reviews to maintain accuracy rates and meet Key Performance Indicators (KPIs).
- Act as a subject matter expert for complex clinical reviews and payer policy escalations.
- Collaborate with internal and external stakeholders to streamline workflows and reduce days in accounts receivable (AR).
- Prepare detailed operational reports and performance metrics for management review.
Kualifikasi
- Bachelor’s degree in Nursing, Health Administration, or a related field; active PRC license is a significant advantage.
- Minimum of 3-5 years of experience in Utilization Review, Denials Management, or Medical Billing/Coding within a BPO or healthcare setting.
- Proven leadership experience with the ability to manage and motivate remote or hybrid teams.
- In-depth knowledge of US Healthcare revenue cycle processes, payer contracts, and medical necessity criteria (e.g., Milliman, InterQual).
- Strong analytical skills with proficiency in Microsoft Excel and healthcare management software.
- Excellent verbal and written communication skills for professional stakeholder interaction.
- Ability to work effectively in a hybrid setup during the day shift.