Audit Technician Denied Medical Claims

3 days ago

Cebu City, Central Visayas, Philippines Health Business Solutions Full time

Key Responsibilities

Review denied medical claims to determine reasons for denial (coding errors, missing information, medical necessity, eligibility, etc.).

Collect, organize, and verify supporting documentation needed for appeals or audit

Prepare and submit claim audit packets for internal review or external payor reconsideration.
Collaborate with clinical staff, coders, and billing teams to resolve discrepancies and correct claim data.
Maintain accurate tracking of denied claims, appeals filed, and outcomes for reporting purposes.
Identify trends in denials and escalate recurring issues to management for process improvement.
Ensure compliance with HIPAA, CMS, and payor guidelines.
Assist with internal audits, quality checks, and special projects as assigned.

Qualifications
Bachelor's degree in healthcare administration, business, or related field preferred.
Minimum of 3 years prior experience in medical claims, billing, coding, or auditing highly desirable.Knowledge of ICD-10, CPT, and HCPCS coding, as well as medical terminology.Familiarity with payor policies, EOBs, and claim adjudication processes.
Strong organizational skills with attention to detail and accuracy.Ability to work with confidential patient and claims information in compliance with HIPAA.
Proficiency in Microsoft Office Suite and experience with claims management systems (Epic, Facets, Availity, etc. preferred).

Skills & Competencies
Analytical thinking and problem-solvingStrong written and verbal communication
Time management and multitasking
Collaboration and teamwork
Process improvement mindset

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