Staff nurse

Job Description

USRN Team Lead | Denials and Appeals | WFH after Training

We currently looking for USRN Team Lead to be part of our PIONEER USRN TEAM!

Key Responsibilities:

Team Leadership:

• Supervise, mentor, and support a team of nurses and analysts handling clinical denials and appeals.
• Monitor daily workload distribution and productivity, ensuring team meets quality and turnaround standards.
• Provide training and development opportunities for team members to enhance performance and knowledge.

Denials and Appeals Oversight:

• Oversee clinical review of denied claims, ensuring timely and effective appeal submissions.
• Evaluate medical necessity, documentation, and payer guidelines to develop strong clinical arguments.
• Serve as an escalation point for complex or high-value denials requiring expert-level intervention.

Reporting and Communication:

• Analyze team performance metrics and denial trends; report findings to leadership regularly.
• Collaborate cross-functionally with coding, billing, utilization review, and provider teams.
• Maintain up-to-date knowledge of payer policies, appeal timelines, and documentation standards.

Qualifications/Requirements

Qualifications:

• Must have an active USRN license
• At least 1 year of hospital experience.
• At least 1 year experience as Team Lead/Supervisor in healthcare BPO set up
• Experience in Utilization Review, Denials Management, or Appeals Writing
• Must have experience/knowledge in Oncology
• Strong understanding of medical necessity, clinical guidelines ( InterQual, MCG, NCD, LCD ) and payer requirements.
• Excellent written communication and critical thinking skills.
• Experience working with EMRs, UM software, and payer portals.

Work location

TAGUIG CITY, NCR, FOURTH DISTRICT

Remarks

We currently looking for USRN Team Lead to be part of our PIONEER USRN TEAM!

Apply now