Team Leader - Clinical Denials

# Team Leader - Clinical Denials

> Tasq Staffing Solutions, Inc. · Taguig, Philippines · Full-time · Posted 2026-09-10

**Workplace:** on_site

**Department:** Philippines - Corporate

## Description

**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**

• CDAS or equivalent denial management credential.
• CCDS/CDIP or equivalent CDI certification.
• CCS/CPC or equivalent coding certification.
• Experience with Epic and U.S. payer portals.
• Experience managing denial inventory and performance dashboards.

• _**Duties and Responsibilities**_
• **Team Leadership & Operations**

• Leads daily activities of a team of **20+ Clinical Denials Specialists**.
• Assigns and prioritizes denial inventory based on complexity, aging, financial impact, and payer requirements.
• Monitors productivity, quality, turnaround time, and appeal outcomes.
• Provides coaching, mentoring, and performance feedback.
• Supports onboarding and training of team members.
• Escalates operational, clinical, payer, and client issues to management.

**Denial Review & Appeals**

• Reviews complex and high-dollar clinical denials.
• Provides guidance on medical necessity, DRG, level of care, clinical validation, documentation, and coding-related denials.
• Reviews appeal letters for accuracy, completeness, and supporting evidence.
• Supports interpretation of U.S. payer policies and reimbursement requirements.
• Collaborates with CDI, HIM, Coding, Utilization Management, and other RCM stakeholders.

**Quality & Denial Prevention**

• Partners with QA to address quality findings and performance gaps.
• Identifies recurring denial trends and opportunities for prevention.
• Supports root-cause analysis and process improvement initiatives.
• Ensures work complies with client requirements, payer policies, privacy, and organizational standards.

**Reporting & Stakeholder Management**

• Reviews team performance reports and KPIs.
• Communicates trends, risks, and action plans to management.
• Supports client and internal meetings as required.
• Maintains effective communication with U.S.-based stakeholders.

## Apply
[Apply at Tasq Staffing Solutions, Inc.](https://apply.workable.com/tasq-work/j/DAC6F3C3F1/apply)
---
Powered by [Workable](https://www.workable.com)