Certified Professional Coder

1 day ago

Makati City, National Capital Region, Philippines Genfinity Philippines, Inc. Full time ₱600,000 - ₱800,000 per year

Job Summary

A Certified Professional Coder (CPC) will focus on conducting Level of Service audits, ensuring accurate coding of medical procedures and diagnoses, and maintaining compliance with federal, state, and payer-specific regulations. The ideal candidate will have a strong background in Workers' Compensation, fee schedule application, and medical documentation analysis.

Primary Duties & Responsibilities

  • Perform Level of Service audits on medical bills to validate coding accuracy and appropriateness.
  • Review and interpret complex medical documentation including office visits, consultations, surgeries, and hospital services.
  • Apply CPT, ICD-10, and HCPCS coding standards to ensure proper billing and reimbursement.
  • Ensure compliance with state-specific fee schedules, Workers' Compensation regulations, and payer guidelines.
  • Identify and resolve discrepancies in coding and documentation.
  • Respond to provider appeals and inquiries with clear, regulation-based explanations.
  • Collaborate with internal teams including customer service, billing, and compliance to resolve coding issues.
  • Maintain up-to-date knowledge of coding guidelines, regulatory changes, and industry best practices.
  • Protect the confidentiality of patient and provider information.
  • Participate in ongoing training and maintain active CPC certification and required CEUs.

Qualifications

  • Experience with multi-state jurisdictional regulations.
  • Understanding of Usual & Customary, PPO discounts, and non-fee schedule claims.
  • Minimum 2 years of experience in medical coding, preferably in Workers' Compensation or medical bill review.
  • Background in hospital billing guidelines for inpatient and outpatient services.
  • Prior experience in level of service auditing or clinical documentation improvement (CDI).
  • CPC (Certified Professional Coder) certification required; CCS or CPC-A considered with relevant experience.
  • Strong knowledge of CPT, ICD-10, HCPCS, and medical terminology.
  • Familiarity with CompIQ Solutions or similar bill review platforms preferred.
  • Excellent analytical, communication, and problem-solving skills.
  • Ability to work independently and manage multiple priorities in a fast-paced environment.

Job Types: Full-time, Permanent

Benefits:

  • Health insurance
  • Opportunities for promotion
  • Paid training
  • Promotion to permanent employee

Work Location: In person

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