USRN Quality Assurance Analyst – Healthcare

Gratitude Inc

446 Views

1 month ago

USRN Quality Assurance Analyst – Healthcare

2-3 Year(s)

₱ 80 - ₱ 120K p.m

Manila (Makati)

Quick Apply Apply

Job Description

Key Skills

Analytical Documentation HIPAA Problem-Solving Skills Proficient in MS Office Excellent written and verbal communication skills.

53 candidate(s) have already applied for this Job. Apply now

Job Title: USRN Quality Assurance Analyst – Healthcare

Location: TP Alphaland (Onsite)
Shift: Graveyard Shift
Salary: PHP 80,000 – 120,000
Employment Type: Full-time

Note: Former Teleperformance employees are not eligible for rehire, either directly or through a third party.

Job Overview

We are hiring a USRN Quality Assurance Analyst to support a U.S. Healthcare account. The selected candidate will be responsible for auditing clinical transactions, evaluating documentation quality, ensuring compliance with U.S. healthcare standards, and providing coaching and feedback to improve clinical performance.

Key Responsibilities

Conduct quality audits for Utilization Management (UM), Case Management (CM), Clinical Triage, Medical Necessity Reviews, and Clinical Documentation.
Ensure compliance with MCG/Milliman, InterQual, CMS guidelines, HIPAA, and client-specific standards.
Review documentation for accuracy, completeness, and clinical compliance.
Provide structured feedback and coaching to nursing teams.
Prepare quality reports, trend analyses, and calibration summaries.
Identify quality gaps and recommend process improvements.
Participate in internal and client calibration sessions.
Support quality improvement initiatives and regulatory compliance.

Qualifications

Philippine Registered Nurse (PHRN).
Active, unrestricted USRN License.
Minimum 2 years of clinical bedside experience (ER, ICU, Med-Surg, or Telemetry preferred).
Minimum 1 year of USRN BPO/U.S. Healthcare experience in Utilization Management, Case Management, Appeals, Triage, or related processes.
Previous experience as a Quality Analyst, Clinical Auditor, or Clinical Reviewer in a U.S. Healthcare account.
Strong knowledge of HIPAA, MCG/Milliman, InterQual, and U.S. medical terminology.
Experience handling or reviewing medical documentation.
Excellent written and verbal English communication skills.
Strong analytical, documentation, and problem-solving skills.
Knowledge of ICD-10 and CPT coding is an advantage.
Proficient in MS Office and QA evaluation tools.

Recruitment Process

Validation
Initial Interview
Two Assessments
Client-Specific Assessment
Operations Interview
Final Operations Interview

Pre-Screening Questions

Educational Qualification:
Total years of experience in medical accounts (clerical or administrative support):
Do you have an active USRN License? If yes, what is its validity?
Total years of experience as a Quality Analyst:
Current/Last Drawn Salary:
Expected Salary:

Questionnaire Link

https://myglit.com/lateral/cref/f7e0e48032

Important Note

Filling out this form is mandatory. Only candidates who complete the questionnaire will be considered for the recruitment process.

Role

Quality Coach

Timings

Night Shift (Permanent)

Industry

BPO

Work Mode

Work from office

Process

Voice

Functional Area

ITES / BPO / Customer Service

Note: Myglit doesn't charge any money from candidates. If you have been asked to pay money to get this job then report to us immediately at support@myglit.com.