PHRN - Medical Coding Manager
15 hours ago
Job Profile Summary Responsible for auditing inpatient medical records to ensure clinical documentation supports the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims. Primary duties may include, but are not limited to: Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines, and objectivity in the performance of medical audit activities. Draws on advanced ICD-10 coding expertise, mastery of clinical guidelines, and industry knowledge to substantiate conclusions. Utilizes audit tools, auditing workflow systems and reference information to generate audit determinations and formulate detailed audit findings letters. Maintains accuracy and quality standards as established by audit management. Identifies potential documentation and coding errors by recognizing aberrant coding and documentation patterns such as inappropriate billing for readmissions, inpatient admission status, and Hospital-Acquired Conditions (HACs). Suggests and develops high quality, high value, concept and or process improvement and efficiency recommendations. Qualifications Requires current, active, unrestricted Registered Nurse license in applicable state(s) and minimum of 10 years of experience in claims auditing, quality assurance, or clinical documentation improvement, and a minimum of 5 years of experience working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG. One or more of the following certifications are preferred: Certified Clinical Documentation Specialist (CCDS), Certified Documentation Improvement Practitioner (CDIP), Certified Professional Coder (CPC) or Inpatient Coding Credential such as CCS or CIC. Experience with third party DRG Coding and/or Clinical Validation Audits or hospital clinical documentation improvement experience preferred. Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing guidelines, payer reimbursement policies, and coding terminology preferred. 5 years of Management experience. #J-18808-Ljbffr
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USRN PHRN Representative
4 weeks ago
Taguig, Philippines HRTX Full timeThis role is responsible for improving the quality, accuracy, and completeness of clinical documentation in the medical record. This role collaborates with physicians, coders, and other healthcare team members to ensure documentation reflects the true clinical picture, supports appropriate code assignment, and meets regulatory and quality reporting...
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USRN PHRN Representative
3 weeks ago
Taguig, Philippines HRTX Full timeThis role is responsible for improving the quality, accuracy, and completeness of clinical documentation in the medical record. This role collaborates with physicians, coders, and other healthcare team members to ensure documentation reflects the true clinical picture, supports appropriate code assignment, and meets regulatory and quality reporting...
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USRN PHRN Representative
3 days ago
Taguig, National Capital Region, Philippines HRTX Full time ₱900,000 - ₱1,200,000 per yearThis role is responsible for improving the quality, accuracy, and completeness of clinical documentation in the medical record. This role collaborates with physicians, coders, and other healthcare team members to ensure documentation reflects the true clinical picture, supports appropriate code assignment, and meets regulatory and quality reporting...
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Phrn
3 days ago
Taguig, National Capital Region, Philippines HRTX Full time ₱35,000 - ₱50,000 per yearWe're Hiring: PHRN Quality Auditor Clinical Services Location: Onsite, Mckinley, Taguig Schedule: Night Shift | Monday to Friday Hiring Target Date: Preferably by July 21, 2025 Salary Range: Up to 50kQualifications Must hold an active PHRN license (Not a USRN holder) Prior experience as a Quality Auditor in a healthcare BPO clinical setting Alternatively, 4...
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Medical Coding Manager
2 weeks ago
Taguig, National Capital Region, Philippines AGS health Full time ₱1,500,000 - ₱3,000,000 per yearJob Title: Coding/Medical Coder ManagerLocation: McKinley, TaguigWork set-up: OnsiteShift: Morning ShiftOverview:Under the direction of the Medical Coding Vertical at AGS health, with ROI/Voice/ Medical Coding, SME will be responsible for governing learning rigor, behavioral and customer service, responsible for the design, delivery, and continuous...
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PHRN – Clinical Authorization
3 weeks ago
Taguig, Philippines Go-Get Data Consultancy Full timeOverview Job title: PHRN – Clinical Authorization Work set up: Onsite Opportunity – MCK Taguig, Cyber Sigma Building Work schedule: Weekdays Night Shift schedule, Fixed Weekends Off Salary: 45K to 50K package if licensed PHRN, salary for approval if non-licensed Responsibilities Contact insurance carriers to verify patient’s insurance eligibility,...
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Taguig, Philippines Nezda Technologies Inc. Full timeOverview Urgent Hiring for PHRN & USRN! Start ASAP! Virtual Process Only! Get your JO Now! Work Onsite: BGC, Taguig City Position: PHRN - Telephonic Case Manager Responsibilities Evaluate treatment authorization requests based on state guidelines and medical necessity, making a decision to approve or deny. If denied, refer the request to an independent panel...
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Medical Coder Trainee
3 days ago
Taguig, National Capital Region, Philippines Tri-Unity Talent Sourcing & HR Management Services Full time ₱150,000 - ₱250,000 per yearThe Medical Coder Trainee will be responsible for learning and applying coding standards for medical diagnoses and procedures.Assist in coding medical recordsLearn to use coding softwareParticipate in training sessionsFor Non-IP CodersAt least 1 year of Profee, ED, OBS, or SDS coding experienceFor IP CodersAt least 6 months of IP coding...
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USRN - Medical Coding Manager
4 weeks ago
Taguig, Philippines Carelon Global Solutions Full timeOverview Job Profile Summary: Responsible for auditing inpatient medical records to ensure clinical documentation supports the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims. Primary duties may include, but are not limited to: Analyzes and audits claims by integrating medical chart coding...
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Medical Coding Scholar for Inpatient Coding
3 days ago
Taguig, National Capital Region, Philippines Conifer Health Solutions Full time ₱25,000 - ₱50,000 per yearConifer Global Business Center Inc. is hiring outpatient medical coders who are ready to advance their careers by training in inpatient medical coding through our Coding University.What's in it for you?We have a team of highly experienced and skilled professionals to help and provide you with comprehensive training and grow a promising career in the Medical...
