Edit Resolution Analyst/ Denial Management Medical Coder

3 weeks ago

Metro Manila, Philippines Tenet Global Business Center, Inc. Full time

This position is responsible for identifying, capturing, tracking, reviewing, and resolving held claim edits, claim rejections, and/or denials that result from the claims/billing cycle.  This position ensures all resolutions utilized are in accordance with policies, procedures, official coding guidelines/advice, rules and regulations (payer, state, and/or federal).  Position requires a working knowledge of ICD-10-CM, ICD-10-PCS, CPT, and HCPCS codes and any appropriate modifiers, various payment methodologies, as well as working knowledge of appropriate, compliant hospital and provider billing and charging practices.  

  • Identifies, tracks, and reviews revenue cycle held claim edits, rejections, and/or denials including verifying legal health record documentation to identify appropriate resolution and/or preventative solution to the identified claim/billing edits, errors, omissions, rejections, and/or denials including correcting and resubmitting the claim. This may include data quality reviews on diagnosis and procedure codes and/or charges as well as addressing NCCI (national correct coding initiative), OCE (outpatient code editor), NCD (national coverage determination), and LCD (local coverage determination) edits as appropriate to the edit, rejection, and/or denial worked.  Verifies all worked claims are to the payer within timely filing limits.  Meets and/or exceeds established productivity and quality standards. Adheres to Standards of Ethical Coding as set for by the American Health Information Management Association.
  • Identifies, tracks, and monitors any revisions and/or corrections they make to the claims processing system to ensure corrections occur in a timely manner.  In-depth critical thinking, research, and analysis is required. Strong working knowledge of ICD-10-CM, ICD-10-PCS, HCPCS, CPT codes, modifiers, charging, and payment methodologies are essential.
  • Maintain proficiency in injection and infusion CPT coding/charging and abstracting to identify procedures performed.

    Work Experience: 

  • 2 or more years of direct, recent experience in a hospital setting, healthcare industry, revenue cycle, revenue integrity and/or coding operations resolving held claims with a focus in two or more of the following areas:  coding, coding quality/compliance, documentation integrity, charge validation, charge/revenue integrity, charge compliance, charge audit, CDM management/maintenance and/or denials prevention/management.
3 or more years’ recent experience in ICD, CPT, and HCPCS proficient code assignment including, but not limited to, Evaluation & Management codes (technical and professional), injection and infusion coding guidelines, interventional services, observation services, as well as appropriate modifier assignment. Experience in a complex multi-entity organization or with large complex revenue cycle services preferred.Proficient in compliant charging and billing practices. Proficient in state and federal charging and billing regulations.

Required Certification/ Licensure:

Professional certification through AHIMA (RHIA, RHIT, CCS, CCS-P) and/or AAPC (CPC, COC, or CIC) required. Will consider years of direct, relevant experience in lieu of certification. Active certification from AHIMA or AAPC is required within one year of employment.Nursing education/licensure desirable (i.e. RN, LPN, LVN)

Working Conditions:

Amenable to work onsite in BGC, TaguigWilling to work in a dayshift schedule

Company Benefits:

Competitive SalaryHMO on day 1 plus 1 dependent; Additional 1 HMO dependents upon regularizationPTO CreditsAnnual AppraisalAnnual Performance Bonus

  • Edit Resolution Analyst/ Denial Management Medical Coder

    3 weeks ago

    Manila, National Capital Region, Philippines Tenet Global Business Center, Inc. Full time

    This position is responsible for identifying, capturing, tracking, reviewing, and resolving held claim edits, claim rejections, and/or denials that result from the claims/billing cycle. This position ensures all resolutions utilized are in accordance with policies, procedures, official coding guidelines/advice, rules and regulations (payer, state, and/or...

  • Medical Coder

    13 hours ago

    Manila, National Capital Region, Philippines Access Healthcare Services Manila, Inc. Full time

    Experienced Inpatient/Outpatient Medical Coders sought for a dynamic team. Access Healthcare is looking for experienced Inpatient/Outpatient Medical Coders to join our team. The ideal candidate will have at least 3 years of outpatient coding experience in one or more of the following specializations: Inpatient DRG, Clinical Documentation Specialist,...

  • Medical Coder

    3 days ago

    Manila, National Capital Region, Philippines Access Healthcare Services Manila, Inc. Full time

    Experienced Inpatient/Outpatient Medical Coders sought for a dynamic team. Access Healthcare is looking for experienced Inpatient/Outpatient Medical Coders to join our team. The ideal candidate will have at least 3 years of outpatient coding experience in one or more of the following specializations: Inpatient DRG, Clinical Documentation Specialist,...

  • Medical Coders

    4 weeks ago

    Manila, National Capital Region, Philippines Access Healthcare Services Manila, Inc. Full time

    Access Healthcare is looking for experienced Inpatient/Outpatient Medical Coders to join our healthcare BPO team. The ideal candidate will have at least 3 years of outpatient coding experience in one or more of the following specializations: Inpatient DRG, Clinical Documentation Specialist, Emergency Department (ED) Facility, Observation, Evaluation...

  • Medical Coders

    4 weeks ago

    Metro Manila, Philippines Access Healthcare Services Manila, Inc. Full time

    Access Healthcare is looking for experienced Inpatient/Outpatient Medical Coders to join our healthcare BPO team. The ideal candidate will have at least 3 years of outpatient coding experience in one or more of the following specializations: Inpatient DRG, Clinical Documentation Specialist, Emergency Department (ED) Facility, Observation, Evaluation...

  • Outpatient Medical Coders

    4 weeks ago

    Manila, National Capital Region, Philippines Access Healthcare Services Manila, Inc. Full time

    Access Healthcare is looking for experienced Outpatient Medical Coders to join our healthcare BPO team. The ideal candidate will have at least 3 years of outpatient coding experience in one or more of the following specializations: Emergency Department (ED) Facility, Observation, Evaluation Management (E/M), Denials and Appeals, and Same Day Surgery. This...

  • Senior Medical Coder

    2 weeks ago

    Manila, National Capital Region, Philippines Access Healthcare Services Manila, Inc. Full time

    Access Healthcare is looking for experienced Inpatient/Outpatient Medical Coders to join our PIONEER TEAM team. The ideal candidate will have at least 3 years of outpatient coding experience in one or more of the following specializations: Inpatient DRG, Clinical Documentation Specialist, Emergency Department (ED) Facility, Observation, Evaluation Management...

  • Medical Coder

    3 weeks ago

    Metro Manila, Philippines Manpower Philippines Remote Work Freelance Full time

    About the roleManpower Philippines is seeking a skilled Medical Coder / Risk Adjustment Coder to join our team on a contract basis. This critical role will be based in Bonifacio Global City, Taguig City, Metro Manila and involves coding and classifying medical records to ensure accurate billing and reimbursement.What you'll be doingReview and analyse medical...

  • Medical Coder

    3 weeks ago

    Manila, National Capital Region, Philippines Manpower Philippines Full time

    About the roleManpower Philippines is seeking a skilled Medical Coder / Risk Adjustment Coder to join our team on a contract basis. This critical role will be based in Bonifacio Global City, Taguig City, Metro Manila and involves coding and classifying medical records to ensure accurate billing and reimbursement.What you'll be doingReview and analyse medical...

  • Outpatient Medical Coders

    4 weeks ago

    Metro Manila, Philippines Access Healthcare Services Manila, Inc. Full time

    Access Healthcare is looking for experienced Outpatient Medical Coders to join our healthcare BPO team. The ideal candidate will have at least 3 years of outpatient coding experience in one or more of the following specializations: Emergency Department (ED) Facility, Observation, Evaluation Management (E/M), Denials and Appeals, and Same Day Surgery. This...

  • Medical Coder | Pioneer Team | Pasay

    7 days ago

    Metro Manila, Philippines Access Healthcare Services Manila, Inc. Full time

    Access Healthcare is looking for experienced Inpatient/Outpatient Medical Coders to join our PIONEER TEAM team. The ideal candidate will have at least 3 years of outpatient coding experience in one or more of the following specializations: Inpatient DRG, Clinical Documentation Specialist, Emergency Department (ED) Facility, Observation, Evaluation Management...

  • Senior Medical Coder | Pioneer Team | Pasay

    2 weeks ago

    Metro Manila, Philippines Access Healthcare Services Manila, Inc. Full time

    Access Healthcare is looking for experienced Inpatient/Outpatient Medical Coders to join our PIONEER TEAM team. The ideal candidate will have at least 3 years of outpatient coding experience in one or more of the following specializations: Inpatient DRG, Clinical Documentation Specialist, Emergency Department (ED) Facility, Observation, Evaluation Management...

  • Medical Coder | IP/OP | Pioneer Team | Pasay

    7 hours ago

    Metro Manila, Philippines Access Healthcare Services Manila, Inc. Full time

    Access Healthcare is looking for experienced Inpatient/Outpatient Medical Coders to join our PIONEER TEAM team. The ideal candidate will have at least 3 years of outpatient coding experience in one or more of the following specializations: Inpatient DRG, Clinical Documentation Specialist, Emergency Department (ED) Facility, Observation, Evaluation Management...

  • Denials Management Analyst

    1 week ago

    Metro Manila, Philippines KMC Solutions Full time

    Make your next big career move by applying as KMC Solutions’ next PHRN CLINICAL DENIALS AND APPEALS NURSE (PHRN)!The main responsibilities of a PHRN CLINICAL DENIALS AND APPEALS NURSE (PHRN) include:Effectively review inpatient and/or outpatient medical necessity and authorization denials to determine and understand the validity of such denials in a timely...

  • Medical Coders

    3 weeks ago

    Metro Manila, Philippines GECO Asia Pte. Ltd Full time

    KEY RESPONSIBILITIESAssigns Diagnosis Codes: Utilizes the Official ICD-10-CM Guidelines for Coding and Reports to accurately map conditions to the CMS-Hierarchical Condition Categories (CMS-HCC) for the applicable service year(s).Reviews Medical Charts: Effectively employs computer-assisted coding tools to review and interpret medical records, applying a...

  • Denials Management Analyst

    1 week ago

    Manila, National Capital Region, Philippines KMC Solutions Full time

    Make your next big career move by applying as KMC Solutions' next PHRN CLINICAL DENIALS AND APPEALS NURSE (PHRN)The main responsibilities of a PHRN CLINICAL DENIALS AND APPEALS NURSE (PHRN) include:Effectively review inpatient and/or outpatient medical necessity and authorization denials to determine and understand the validity of such denials in a timely...

  • Medical Coders

    3 weeks ago

    Manila, National Capital Region, Philippines GECO Asia Pte. Ltd Full time

    KEY RESPONSIBILITIESAssigns Diagnosis Codes: Utilizes the Official ICD-10-CM Guidelines for Coding and Reports to accurately map conditions to the CMS-Hierarchical Condition Categories (CMS-HCC) for the applicable service year(s).Reviews Medical Charts: Effectively employs computer-assisted coding tools to review and interpret medical records, applying a...

  • Certified Medical Coder

    1 month ago

    Metro Manila, Philippines Medical & Business Virtual Assistants 24-7 Full time

    Company Overview:We are a company built on trust and loyalty. MBVA 24/7 started in 2018 and has continuously fostered skilled and talented Virtual Assistants for many clients. Our team of virtual assistants provides services all over the US, and we sure won’t be stopping there! Our main office is located in Arizona and Manila. We have a legion of virtual...

  • medical coders

    4 weeks ago

    Manila, National Capital Region, Philippines Pan Asia Resources PH Inc. Full time

    Key roles: · Assigns diagnosis codes according to the Official ICD-10-CM Guidelines for Coding and Reports for conditions which map to the Center for Medicare & Medicaid Services' Hierarchical Condition Categories (CMS-HCC) applicable for the year(s) of service being reviewed· Conducts thorough review of charts by effectively using computer-assisted coding...

  • Medical Coder

    4 weeks ago

    Metro Manila, Philippines Private Advertiser Full time

    DescriptionWe're looking for a Medical Coder, working in Staffing/Recruiting industry in Ayala Avenue, Makati City, Metro Manila, 1223, Philippines. Review medical records and assign accurate ICD-10-CM, ICD-10-PCS, CPT, and HCPCS codes to diagnoses and procedures. Documentation Review: Ensure completeness of medical records for accurate coding and...