PHRN - Medical Coding Operations Expert

20 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 operational training; assists associates by answering day-to-day technical questions; encourages a teamwork environment; monitors inventory to ensure workflow remains uninterrupted; handles complex case research and resolution; reviews, interprets and maintains records of service level, quality, accuracy, and productivity; reviews department policy and procedure manuals for accuracy; works with stakeholder partners/ departments to ensure procedures and policies are accurate and complete.

Qualifications

  • Minimum 5 years related experience and 3 years of experience and expertise with company relevant automated processing systems; or any combination of education and experience, which would provide an equivalent background.
  • Previous leadership, quality audits and/ or training experience preferred.
  • Suggests and develops high quality, high value, concept and or process improvement and efficiency recommendations.
  • Requires current, active, unrestricted Registered Nurse license in applicable state(s) or territory of the United States.
  • 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

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