QA - Clinical Denials

Work setup: ONSITE / BGC, Taguig within 6 months then transfer to Bridgetowne, QC

Work schedule: Nightshift

The QA – Clinical Denials is responsible for conducting quality audits of clinical denial reviews, appeal preparation, documentation, coding validation, and denial management activities to ensure accuracy, compliance, consistency, and adherence to client and payer requirements.

This role evaluates the quality of work performed by Clinical Denials Specialists, identifies errors and opportunities for improvement, provides actionable feedback, and supports continuous improvement of clinical denial processes. The QA is expected to apply strong clinical, coding, reimbursement, and documentation knowledge while maintaining a high level of attention to detail.

The role works closely with Clinical Denials Specialists, Team Leads, Managers, CDI, HIM, Coding, and other revenue cycle stakeholders to improve appeal quality, reduce avoidable errors, and strengthen denial recovery outcomes.

Qualifications

Required

• Bachelor's degree in Nursing, Healthcare Administration, Health Information Management, or related healthcare field.
• Active RN license or applicable clinical credential.
• Minimum 2 to 3 years of healthcare experience in clinical denials, CDI, utilization management, coding, RCM, clai