Posted By: Okonkwo Sandra
Job Description
- USRN
- Utilization Management
- quality assurance Bpo
- Clinical Denials and appeals
- InterQual Process
- Grievances Support Experience
-
Description / Requirements
Job Title: USRN Quality Assurance Specialist
Shift: Night shift
Work Set-up: On-site in Bridgetowne, Quezon City
Salary range: 60K to 90K
Start date: Dec 31, 2025/ ASAP
Recruitment Process: 2 Virtual interview processes
QUALIFICATIONS:
• Bachelor’s Degree in Nursing with an active and valid license in USRN Massachusetts
• Minimum of 1 year experience in appeals and grievances workstream with focus on Medicare Part C Appeals
•At least 1 year to 2 years experience as a Quality Assurance or Quality Evaluator in a clinical BPO or CPO setting
• In-depth knowledge and understanding of CMS Medicare Part C Appeals regulatory standards
• Strong understanding of clinical terminology, medical necessity review principles and healthcare insurance operations
• Experience supporting external audits (CMS Program Audits) and Client Audits
• Must have an experience in mentoring or coaching new quality staff
• Excellent verbal and written communication skills
• High attention to detail with strong documentation, writing, and scoring calibration skills
• Proficiency in Quality Audit Systems and Microsoft Office Suite
• Strong analytical, critical thinking and problem solving skills
• Excellent communication, coaching, and collaboration abilities
• InterQual experience of at least 1 year (Medicare and Medicaid)
• Willingness to work on-site with flexible schedules, including US hours and holidays
• Must not be a current or former employee of Concentrix
PRE-SCREENING QUESTIONS:
- Do you have an active USRN license?
- How many years of experience do you have in clinical appeals and grievances ?
- How many years of experience do you have as a Quality Assurance or Quality Evaluator in a clinical BPO or CPO setting?
- Rate your knowledge and understanding of CMS Medicare Part C Appeals regulatory standards, from 1 to 10, 10 being the highest.
5.Do you have experience supporting external audits (CMS Program Audits) and Client Audits? - Please rate your knowledge and understanding of different healthcare insurance processes, appeals, grievances, and utilization management, from 1 to 10, 10 being the highest.
- Do you have InterQual experience?
- How much is your last drawn salary?
- How much is your salary expectation?
- Are you amenable to working onsite in Bridgetowne, Quezon City, with a night shift and fixed weekends off schedule?
- This is an urgent hiring. Can you start on Dec 31st, 2025?
N/B: Please include the answers to the pre screening test along side with your cv. Thank you