USRN Quality Assurance Specialist

Gratitude Inc

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1 month ago

USRN Quality Assurance Specialist

2-5 Year(s)

Manila (Bridgetown quezon City)

Job Description

Key Skills

excellent verbal and written skills InterQual Process

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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

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

Role

Account Manager

Timings

Night Shift (Permanent)

Industry

BPO

Work Mode

Work from office

Process

Voice

Functional Area

ITES / BPO / Customer Service

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