Team Leader - Clinical Denials

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

Work schedule: Nightshift

The Team Lead – Clinical Denials provides operational and clinical leadership to a team of Clinical Denials Specialists supporting U.S. healthcare clients. The role oversees daily workflow, productivity, quality, employee performance, complex denial escalations, and denial prevention activities.

The Team Lead serves as a subject-matter resource for medical necessity, clinical documentation, DRG, level of care, coding, reimbursement, and U.S. payer requirements.

Qualifications:

Required

• Bachelor’s degree in nursing, Healthcare Administration, Health Information Management, or related field.
• Valid Philippine RN license/PRC registration for RN-required positions.
• 3 to 5 years of experience in U.S. healthcare RCM, clinical denials, CDI, utilization management, claims, or appeals.
• Demonstrated experience leading or mentoring healthcare teams, preferably 20+ employees.
• Strong knowledge of medical necessity, DRG, level of care, clinical documentation, coding, reimbursement, and U.S. payer policies.
• Strong communication, analytical, problem-solving, and people-management skills.
• Willingness to work U.S.-aligned shifts as required.

Preferred