PHRN - Medical Coding Quality Analyst

3 hours ago

Manila, National Capital Region, Philippines Carelon Global Solutions Full time ₱40,000 - ₱80,000 per year

Responsible for evaluating the quality of services and interactions provided by organizations within the enterprise.

Primary duties may include, but are not limited to:

  • Evaluates the quality and accuracy of transactions and/or communications with providers, groups, and/or policyholders.
  • Identifies, documents, and reports any transaction errors or communications issues in a timely manner to ensure prompt resolution.
  • Tracks and trends audit results, providing feedback to management.
  • Conduct calibration sessions to evaluate and ensure that all teams are aligned with the set QA guidelines.
  • Identifies and reports on systemic issues which create ongoing quality concerns.
  • Conducts root cause analysis to determine the underlying causes of noted quality opportunities using the RCA tools.
  • Recommend, implement, and monitor preventive and corrective actions to ensure that quality standards are achieved.
  • Generates monthly reports of audit findings, supports clients with issues identified and develops reports to assist management with information requested.
  • Produces other ad hoc reports as requested by internal and external clients.
  • Associates at this level conduct routine to complex audits, generally related to one or more functions on one or more systems platform for one or more lines of business.

Qualifications

  • Requires a BS Nursing degree.
  • Current and active registered Philippine Nurse license.
  • At least 3 year QA experience.
  • Working knowledge of healthcare industry and medical terminology, detailed knowledge of relevant systems and proven understanding of processing principles, techniques and guidelines; and ability to acquire and perform progressively more complex skills and tasks in a production environment required.
  • Suggests and develops high quality, high value, concept and or process improvement and efficiency recommendations.
  • Minimum of 2 years hospital experience and/or several years of inpatient hospital coding experience.
  • 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

  • PHRN - Medical Coding Operations Expert

    2 weeks ago

    Manila, National Capital Region, Philippines b707e90b-bfaa-4036-9cae-f80dbd385947 Full time $60,000 - $80,000 per year

    Job Description:Responsible for providing domain-expertise, process-related guidance, may assume quality audit, trainer/ coding instructor and/or team management leadership and support, as per business need.Primary duties may include, but are not limited to:Serves as a first line resource for operation associates for workflow and technical related...

  • Medical Biller or Revenue Cycle Analyst

    2 weeks ago

    Manila, National Capital Region, Philippines Theoria Medical Full time ₱30,000 - ₱45,000

    Position Type: Full-time, Non-exemptCompensation: Php 30,000 to 45,000 per month (All-in salary package)Job Location: Remote (PH)Company Overview Theoria Medical is a comprehensive medical group and technology company dedicated to serving patients across the care continuum with an emphasis on post-acute care and primary care. Theoria serves facilities...

  • Medical Biller or Revenue Cycle Analyst

    2 weeks ago

    Manila, National Capital Region, Philippines Theoria Medical Full time ₱30,000 - ₱45,000

    Position Type: Full-time, Non-exemptCompensation: Php 30,000 to 45,000 per month (All-in salary package)Job Location: Remote (PH)Company Overview Theoria Medical is a comprehensive medical group and technology company dedicated to serving patients across the care continuum with an emphasis on post-acute care and primary care. Theoria serves facilities...

  • Medical Biller or Revenue Cycle Analyst

    2 weeks ago

    Manila, National Capital Region, Philippines Theoria Medical Full time ₱360,000 - ₱540,000 per year

    Position Type:Full-time, Non-exemptCompensation:Php 30,000 to 45,000 per month (All-in salary package)Job Location:Remote (PH)Company OverviewTheoria Medical is a comprehensive medical group and technology company dedicated to serving patients across the care continuum with an emphasis on post-acute care and primary care. Theoria serves facilities across the...

  • PHRN Quality Analyst | Hybrid

    2 weeks ago

    Manila, National Capital Region, Philippines Global Group Innovative Services, Inc. Full time ₱50,000 - ₱56,000 per year

    HIRING NOW: PHRN QUALITY ANALYST – HYBRID & ONSITE (PASIG)Step up your nursing career with a role that values both clinical expertise and analytical excellence. We're looking for passionate Philippine Registered Nurses (PHRNs) who want to make an impact in healthcare operations while enjoying great pay, growth, and flexibility.Work Setup & Locations:Hybrid...

  • Medical Biller or Revenue Cycle Analyst

    2 weeks ago

    Manila, National Capital Region, Philippines Theoria Medical Full time ₱30,000 - ₱45,000

    Position Type: Full-time, Non-exemptCompensation: Php 30,000 to 45,000 per month (All-in salary package)Job Location: Remote (PH)Job Highlights:  Paid Time Off: Relax and recharge with paid vacation and sick leaves.Bonus Boost: Enjoy an extra bonus with our 13th month pay.Health Matters: Get comprehensive HMO coverage upon regularization.Weekends Free: Say...

  • Medical Biller or Revenue Cycle Analyst

    1 hour ago

    Manila, National Capital Region, Philippines Theoria Medical Full time ₱30,000 - ₱45,000

    Position Type: Full-time, Non-exemptCompensation: Php 30,000 to 45,000 per month (All-in salary package)Job Location: Remote (Philippines) Job Highlights:  Paid Time Off: Relax and recharge with paid vacation and sick leaves.Bonus Boost: Enjoy an extra bonus with our 13th month pay.Health Matters: Get comprehensive HMO coverage upon regularization.Weekends...

  • PHRN - Medical Coding Operations Expert

    2 hours ago

    Manila, National Capital Region, Philippines Carelon Global Solutions Full time ₱1,200,000 - ₱2,400,000 per year

    Responsible for providing domain-expertise, process-related guidance, may assume quality audit, trainer/ coding instructor and/or team management leadership and support, as per business need.Primary duties may include, but are not limited to:Serves as a first line resource for operation associates for workflow and technical related processes; provides...

  • Medical Coder Trainee(CSU)

    2 weeks ago

    Manila, National Capital Region, Philippines Tri-Unity Talent Sourcing & HR Management Services Full time ₱250,000 - ₱500,000 per year

    Role DescriptionThis is a full-time, on-site role based in Quezon City, BGC Taguig, and Cebu, for a Medical Coder Trainee (CSU). The primary responsibilities include learning and applying medical coding principles, Upskilling of coding experience from Profee, ED, OBS to IP or SDSQualificationsFor IPFor non-IP Coders must have at-least 1 year of...

  • PHRN Appeals Specialist

    2 hours ago

    Manila, National Capital Region, Philippines Sysgen RPO, Inc. Full time ₱600,000 - ₱1,200,000 per year

    Job SummaryThe PHRN Appeals Specialist is responsible for reviewing, evaluating, and processing medical appeals in accordance with client and regulatory guidelines. The role requires strong clinical knowledge, analytical skills, and the ability to communicate effectively with members and healthcare professionals.QualificationsMust have experience in handling...