Medical Coding Specialist

2 days ago

Manila, National Capital Region, Philippines NextSphere Full time ₱900,000 - ₱1,200,000 per year

ducation & Certification:

  • Bachelor's degree in Health Information Management, Nursing, Allied Health, or related field.
  • Mandatory certification in ICD-10, CPT, and/or HCPCS coding (CPC, CCS, CCA) from recognized international or local bodies.
  • Optional but highly valued: experience with Epic, Cerner, Meditech, or other EHR/EMR systems.

Experience:

  • 3–5+ years of hands-on experience in medical coding, billing, or health records management.
  • Prior exposure to specialized coding domains such as surgery, cardiology, oncology, or rehabilitation is preferred.

Skills & Competencies:

  • Advanced knowledge of ICD-10, CPT, HCPCS, DRG coding, and medical terminology.
  • Deep understanding of HIPAA compliance, regulatory requirements, and claims adjudication.
  • Strong analytical and critical-thinking abilities; able to audit clinical documentation for coding accuracy.
  • Effective communicator with clinical teams, insurance providers, and compliance officers.
  • Ability to train coders or provide guidance on complex coding scenarios.

Key Responsibilities – Medical Coding Specialist

1. Accurate and Compliant Coding

  • Assign and review ICD-10, CPT, and HCPCS codes for inpatient, outpatient, and physician services.
  • Ensure coding accuracy and adherence to payer and regulatory guidelines.
  • Conduct complex chart reviews for high-risk or specialty cases.

2. Clinical Documentation Improvement (CDI)

  • Identify gaps or inconsistencies in clinical documentation; recommend improvements to clinicians.
  • Work with medical teams to ensure all diagnoses and procedures are fully documented and supported for reimbursement.
  • Provide insights on the impact on the revenue cycle and compliance.

3. Billing and Claims Management

  • Collaborate with billing teams to submit accurate insurance claims, minimizing denials.
  • Investigate and resolve coding-related claim rejections or appeals.
  • Monitor claim status and ensure timely reconciliation.

4. Compliance and Audit

  • Ensure all coding activities comply with HIPAA, OSHA, and other regulatory requirements.
  • Prepare for internal and external audits by maintaining comprehensive coding documentation.
  • Conduct periodic coding audits to maintain accuracy and compliance benchmarks.

5. Data Analysis and Reporting

  • Generate performance reports, coding error metrics, and claim denial trends.
  • Provide insights to management on billing efficiencies, compliance risks, and revenue impact.

6. Training and Mentorship

  • Train, mentor, and oversee junior coders or interns.
  • Conduct workshops on updated coding rules, payer policies, and regulatory changes.

7. System Optimization

  • Collaborate with IT/EHR teams to optimize coding workflows within systems like Epic or Cerner.
  • Suggest enhancements for automation tools, coding templates, or AI-assisted coding systems.

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